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VI Piping <br /> A. Associated Piping: ❑o, Above Ground ❑o2 Underground ❑oa Vaulted <br /> B. Underground Piping: ❑oc Gravity ❑o2 Pressure 12 oo Suction ❑04 Unknown <br /> C. Piping Repairs: Not None ❑02 Unknown ❑os Yes, Year of most recent repair: <br /> VII Leak Detection <br /> ❑o, Visual 29 02 Stock Inventory ❑os Tile Drain ❑04 Vapor Sniff Wells ❑os Sensor Instrument <br /> ❑oe Ground Water Monitoring Wells ❑or Pressure Test ❑all Internal Inspection ❑o9 None <br /> ❑to Other: <br /> VIII Chemical Composition of Materials Currently or Previously Stored in Underground Containers <br /> If you checked yes to IV-H you are not required to complete this section, <br /> currently previously Chemical Oa Nor Use Commercial Name (Use apdit,onal paper lot more roorr <br /> noted stoteo CAS u{II known) <br /> ❑of ❑02 <br /> ❑o, ❑02 <br /> D 0 ❑az <br /> EI or D 0 <br /> ❑0, ❑oz Ll <br /> ❑oi ❑02 <br /> a, ❑az <br /> ❑at ❑U <br /> ❑of ❑02 <br /> ❑or ❑oz <br /> Dol D 0 <br /> ❑©I ❑02 <br /> ❑ol D 0 <br /> Is Container located on an Agricultural Farm? ❑o, Yes Z)oz No <br /> IX 1MPORTANTI Head instructions before signing: <br /> Signature: The form must be signed by 1)a principal executive officer at the level of vice-president or by an authorized representative.The representative <br /> must be responsible for the overall operation of the facility where the lank(s)are located.2)a general partner proprietor,or 3)a principal executive officer, <br /> ranking elected official or authorized representative of a puttlic agency <br /> This form has been completed under the penally of perjury and,to the best of my knowledge,is true and correct. <br /> So9nalure <br /> Dale <br /> ✓ 3/13/86 <br /> Pnnled Name Title Phone w/area code <br /> Barrett Kehl Manager 209 823-3101 <br /> Send check to., Hazardous Substance Storage Statement,State Water Resources Control Board, P.O. Box 1,00.Sacramento, CA 95801-0100 <br /> Persia,Fdmg Slatemem Phone w/area code— ---- <br /> (Mrs. ) C. M. Hoelscher 1 (209) 823-3101 <br /> For additional forms or more information call 916/324-1262 <br /> FOR STATE USE ONLY <br /> D Numerr Accounting Number Counly P,urna)cr <br /> �r <br /> 84 U6t7 <br />