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VIII.WI I WI�IvII WIUII 1 Jul Califidi .a Water Resources Control Board i J,i I .zardous Substance Storage Statem� +�b/• Whacn person storing hazardous suh9ances In any untler- the lank.Wastes are Inclutleg. grounp pn4alnli must Isle IMS loan no later than July 1 1904 IAllef October Fee: For each lank registered a$10 lee must Wz paid,except Incl retail 1.1964 and no later than January 1.1985 for ranks used on[arms). gasoline staffers pay 55 per lank. 1 Dallnl4on of Underground Containers Tho law applies to "concrete penalllea:Fur Ipllma to Ilio,me penaay Is$500-55.000 per Gay.it you lalsily Sumps.d00vaulle0 bunbtl tanks of oIDCI underground Lonlamws.' IWater Inlennmfun.you can Lu fined up to$20.000 lot rich day the Into,nation is Code section 13173)All containers.including earlhon walled pas.funds. Incnuocl and ruts not Duch cnuuctud. lagoons and sumps.Thal am Whew IDu nulllld goon burtaCll Iuvul fast register.A lank allatg on the grading Is nor Included.Currencies partially Confidentiality: 11 you nave Inluuna1100 defaced by beau secret laws. bunoalli Iho surface are included Lined ar finished pas,pulls and lagoons Pleuee Which o list or the Inlomfalloe an ens term that fiConhtlunllLl and the are covered it earth has been removed Item the storage side to Construct ruhtn¢uoun ler conlldonliyhly,Including spuci is dilations at mlevanl Stele. the facility. Normal grating Is net Composed construction below greund lacy and Case law. level. Multiple Candlemas:FIII 1 and 11 on one torn and have it blank on all the Definition of Nameless,Substance:Any substance listed InWclion 8382 iumain'ng terms Attach ad loans together securely.II you own more man 0I mu Cabal Cade or in Sodium 25316 of the Health and Safely Code.This 50 lanhs you can btu naormnion on computer IWW Call 016/324 12621p includes'.gasoline,diesel fuel,all Industrial solvents.prelicides,herbicides intumaboe. '. and Imagoes.II the material must ba carnod by a registered hauler,de. This Is not a Permit Application.All Underground Tanks war be subject to posed at at a nalamous waste sae,is explosive,generates pressure due to local reguraUan. Some lurlsdlchons have already begun programs. Crack heal or decomposition or would harm numans or wildlife you must register with your local county government lot further Intormalfon. NOTE: ALL UNDERGROUND CONTAINERS MUST REGISTER EVEN IF STATE AND/OR LOCAL PERMITS ARE IN FORCE. I Owner NYrlu ILtlpvYiul IiYr,W W W PWWc Aq,rKYl 1911vW Msees pY Sofa IIP IL II Facility fere"emC oCaW/fmmlmlSgwvaa SallA ., NWI.0 0.1$a.. cry CamIY IIP kAwN Avul GY 5"s, bP PMn a/BCC IoM pall OI au Wusf ❑of Motor Vehicle Fuel Siouan ❑.Other: NlClwnl d Palaui m'Finer Rural Meas I°"""p avlNu swum Only: Ill 24 Hour Emergency Contact Person p.r'Nwle Vac""a'" P. """u cmc N,vw'tirmu,I.0 rcme a'n w Pew Shift Supervisor - 800-641-7580 Shift Supervisor - 000-641-7580 COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER IV Description COnWnIItl I1xxC„Iu nWlNn.ess4n owl A.IDoi Tank ❑w Sump ❑w Lagoon,Pit or Pend ❑wbineC 005 005 S. Manufacturer(if appropriate): Year of MIg:Unknown C. Year Installed: 0 Unknown D. Container CapacelyIn,On 0 gallons ❑Unknown E. Container Repairs: ®Pt None ❑oz Unknown ❑w Yes Year: F. Is Con)ainer currently used? Mattes ❑w No If No,year of lass use: 13S Unknown G. Does the Container Store(Check One): ❑oi Waste Boz Prdducl [H.fD.Oes IneContinerStore Motor Vehicle Fuel or Waste Oil? DillYes ❑IiaNo II Yes,Check appropriate box(esg Unleaded ❑w Regular ❑w Premium ❑w Diesel ❑m Waste Oil ❑as Other(List): V Container Construction A. Thickness of Primary Containment: kill ❑Gauge 13 Inches ❑cm ❑Unknown B. O M Vaulted(Located in an underground Vault) Hoz Non-vaulted ❑w Unknown C. ❑PI Double Walled Cts,Single Walled E3 of Lined El.Wrapped ❑Ps Unknown qua None D.KI PI Carbon Steel Elm Stainless Steel ❑at Fiberglass ❑w Polyvinyl Chloride Elm Concrete ❑ve Aluminum ❑n Steel Clad ❑of Stoma ❑w Composite ❑n Non•mela[lic ❑ u Eanhen Walls ❑u Unknown ❑n Other: E. ❑4I Rubber Lined ❑.Alkyd Lining 13a,Epoxy Lining ❑of Phenolic Lining ❑u'Glass Lining ❑re Clay Lining fol Unlined 0s Unknown ❑as Other F.0of Polyelhlene Wrap 0w Vinyl Wrapping ❑w Cathodic Protection ❑u Unknown ❑os None 0 as Other:Asphalt is