COMPLIANCE INFO 1987-2011 - Laserfiche WebLink

Home Browse Search

A Associaled F p,ng ❑o' AUMMkGtound Cl - Underground ❑�+VaulleC Asks B Underground Piping Grariay tfn7 Pressure t'8vr5acflom ❑w Unknown lqw C Pipmg Repairs 2 o,None ❑a.Unknown ❑w Yes Year o1 most recent repair V11 Leak Detection o.Visual O aw Stock Inventory 0o Tile Drain ❑a Vapor Sniff Wells ❑m$@nSOr Instrument ❑a Ground Water Monitoring.Wells o*Pressure Test ❑a Internal Inspection 19ydome ED'.,Other V111 Chemical Compoaltlon of Materials Currently or Pretrlously Stored In Underground Container$ It you checked yes to IV-H you are not required to comple4e this Section YYYY.e�.er1' FrtM.r✓r CWAMW pe No use cr w`—+Nan,e lust aw—iii Pturi ru mne rro?• nat0 Pn[a CAS t Iii r.ww^., - In 0, ❑07 ❑OI ❑07LLLL ❑0, ❑a2 ❑o+ 0 ❑0i 0C ❑0. ❑G2 ❑'. ❑a: 17.` ❑07 Is Conta ner located on an Agricuttural Farm? ❑rlt Yes 1%,% No 1X IMPORTANTI Read instructions belore signing Ssagnsturc The lorm must be signed by 11 a principal executive otl,cer al the leve'or vice-pressen!or by ar aulnor.2ec tepiesentalive The represental•re must be responstble for the overall operation of the lacialy where the lank(s)are located 21 a genera''pannei proprietor or 31 a principal exE"c ul"t oft.cer ranking elected official or aulh1302ed+epresemat,ve of a public agency This f orm has been completed under the penally of pequry and to the best of my knowledge is true and correct oa,e sq-- P-e ww Vfa Pnic3 4xme Dist. Staff 415-542-0612 Send cheek to: Hazardous Substance Storage Statement State wafer Resources l Board P o Box 5 Do.Sacramenlo.CA B5BDt-Dt DD Pnc•:. w o 415,5+1 -658' 823`g$2 For eddlllonal forms or more Information call 1116?324-1252 Corrections made by LHCorp. 10-16-86 James Elder, RE14600 FOR STATE USE ONLY Y`J h�mLeACttu+w.nq NumOEi .0^'.h..mpp.