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VI Piping <br /> A. Associated Piping: On, Above Ground No2 Underground 0 o Vaulted <br /> B. Underground Piping 0 or Gravity 0 o2 Pressure INo3 Suction 0 o< Unknown <br /> C. Piping Repairs: fdol None 0 oz Unknown 0 o3 Yes, Year of most recent repair: <br /> VII Leak Detection <br /> )7 or Visual 0 o2 Stock Inventory 0 o,Tile Drain 0 04 Vapor Sniff Wells 0 os Sensor Instrument <br /> 0 nr Ground Water Monitoring Wells 0 or Pressure Test O oe Internal Inspection Dog None <br /> Oro OfIer: 0 • <br /> VIII Chemical Composition of,Materials Currently or Previously Stored in Underground Containers <br /> It you checked yes to IV-H you are not required to complete this section. <br /> eerrerlty previously Chemical On Not Use COlnmerC at Nam se addAmnal onix,for mom mciu <br /> Sbu:d filmed CAS 4111 knOWnl <br /> 001 0o2 <br /> Ont 002 <br /> Om 002 <br /> O n1 002 <br /> Oe1 Oo2 <br /> Oar Ogg <br /> Oar One <br /> 0 0, O o2 <br /> Om 002 <br /> Ont One <br /> Om 002 <br /> 0 o 002 <br /> Dol 002 <br /> Is Container located on an Agricutlrntal Farm? Oar Yes CXr2 No <br /> IX IMPORTANTI Read instructions before signing: <br /> Signature: The form must be signed by 11 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 public agency. <br /> This form has been completed under the penalty of perjury and,to the best of my knowledge.is true and correct <br /> signature bale <br /> August 17, 1987 <br /> PrW,d Nam, Title Plronc w/arca LodC <br /> Marty D. Yocturl Vice President (209)673-7071 <br /> Send check to: Hazardous Substance Storage Stalement. Stale Water Resources Control Board, P.O. Box 100.Sacramento. CA 95801-0100 <br /> Pnrsnn Poing Statement Phone w/arna code <br /> William Me Wathen (209)673-7071 <br /> For additional forms or more Information call 916/324-1262 <br /> FOR STATE USE ONLY <br /> 11l Numb- tr 7my p'!^m, County Number <br /> Dare necnwnd ❑nr ❑ ❑od <br /> 84 37.647 <br /> .3. <br />