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Official R6gistrhon Fori-n
<br /> California Water Resourci Control Board
<br /> Hazardous Substance Storage Statement
<br /> Who Must File: person sKiiirig substances in any under- the tank Wasles are Included
<br /> C'1011,'10 Ci MUS1 1142 this form no laid Inan J�ily 1 1()84 (Atka0i Fee: For onch Jrtrjlk reqiswiecl a SIO foe mi be Paid. except Jhaj retail
<br /> 1. 1984 and no Int,?r ih4n Jai 1 1985 for tanks USC'd Oil 1'rl(IrS). SI,-Ilions-pay$�' per 4irk
<br /> Definition of Underground Containers: The law applies to "concrete Penalties: For lailure,in file.the penally is'500-:55.000 I)c,-r day. 11 voij falsity
<br /> nwivaulud honed tanks Ot other underground Cnivainers." (Waler ininrnialion, you can be fin rd up to $20,000 ror each day theinifor'n"I'lli011 is
<br /> CodL! sc4(,ji,)n 13173} All containers, including elttllmi walled pils, ponds, inca[recl and has not been correcled
<br /> lacloc)nS and sumps, Mat are below the normal ground SUlfaCP level 1711LISI Confidentiality: If you have inlorinallor pfolcClOd by linde secret laws.
<br /> rogistf,ir A tank sNincl or iine CjrnLIOCI IS 1`101 included Containers partially please allach a list�)f t�le information on this Jurni lhal is confidential �nu the
<br /> b0neP,irl IhC SLIOLAi'O are included_La)(KI or unlined po�; ponds and lagoons stificaiion for confidentiality, OCILKIJI�q Si cil'alions of
<br /> relLvanl stali
<br /> ore - tory and case law,
<br /> . cOvowc) if earth has ilcerl winoved from the slcrz.ige xcki to corswict
<br /> It),- lnc,14y, Normal grading is riot Considered construction below groul)(i
<br /> level Multi pie Containers: Fill I and It on One forni and leave it blank on at[the
<br /> remaining forms Allach all t(wins logethCr securely. It you own mote than of Hazardous Substance: Any Substancellst(irl in Section 6382 50 tanks you i lite irilomiation on cornpi tape. Calf 916/324-)262 for
<br /> of We Labor i or n Secuor,25316 of the I-Irallih and SofcJY Cod(-, This inforniatinn.
<br /> includes, 9,9501inii 60901 `v1,1. all indusirlaf Solverls• peSliqdr_S. herbicides
<br /> and himigaills If the n-joicrial must be camLd by q registered hauler, rills- This is not a Permit Application. All Underground Tanks will be subject 10
<br /> local �cqi Si jurisdictions have already begun programs Check_.
<br /> posed of ala hazardous wasle site,is explosivlg'generates pressure(1i to
<br /> heal or cincornposilioil or would hWI11 hi Or WIldlifc YOU a1LISt r0glSler Will- Y()Ijr local r.amn
<br /> NiiiALL UNDERGROUND COli VERS MUSTREGISTER EVEN IF STATE AND/OF �EAL'PERMITS ARE IN FORCE.
<br /> I Owner
<br /> ;,ganryj
<br /> Stale z1f,
<br /> Stockton Ca.
<br /> 11 Facility
<br /> Stockton Nissan -Monte Johnson
<br /> 1847 N. Wilson Way Bradford
<br /> ZIP
<br /> Stockton San Joaquin 95205
<br /> S;110 71P
<br /> P. 0. Box 8850 Stogy, ckton Ca, 95208 --
<br /> Ow Motor Vehicle Fuel Station K o:, Other:
<br /> to IN$, Rural Areas ro'nshi'ly Range Soclrrpn
<br /> Only:
<br /> t
<br /> 24 j—C-o—na--6C
<br /> PcFrsoon .7 —.J
<br /> fua i,Fsr a,io PtPnnE woro,.co,'J,, NW:fs.N81T]e(labi.ribinu IuSij ar)o Prii)ou rxji!
<br /> (20q)94-8--9-027 Jahnitt , nytif-P (209) 957-9677
<br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER
<br /> IV Description
<br /> ani;r
<br /> A. 11i Ko a n k 0 v2 Sump 0 w Lagoon, Pit or Pond 0(14 Other: Contain net Number 111 thea:it Iib iiwGI)o.a5�'irirl
<br /> B Manufacturer (if appropriate}: Year of Mfg., C. Year Installed: 0 Unknown
<br /> D. Container 0 m Yes Year:CapUnknowncily— --:9)--garlons 11 Unknown E. Container Repairs: Doi None J3 Unknown
<br /> F. Is Container currently used? 5Ki Yes 0 cj?. No if No, year of last use: 0 o3 Unknown
<br /> G. Does lite Container Store (Chock bne): Kl Waste 0 n2 Product
<br /> H. Does the Container Store Motor Vehicle FLJOI Of Waste Oil? ��' Yes Owr• No 0 Yes Check appropriate box(es):
<br /> El w L16aded 17 0:1 Regular 0 n3 PFQfniUrn E o4 Diesel o5 Waste Oil 0 o6 Ogler (List),
<br /> V Container Construction
<br /> A. Thickness of Primary Contairnnenl: D Gauge D Inches 0 crn 4Unknown
<br /> B. El or Vaulted (Located in all underground Vault 0 o:? Nan-vaulted Unknown
<br /> C. 00, Double Willed Om Single, Wailed 0 1 Lined 064 Wrapped us Unknown 0 or, None
<br /> D. Oki, Carbon Steel 0 tip Stainless Steel LJ ),I F-iherglass ' 0 04 Polyvinyl Chloride D 05 Concrete El os Aluminum
<br /> 0 07 Steel C18CJ LJ iio Bronze 0 0o Cornposile 0 to Non-metallic 0 1, Earthen Walls
<br /> ra known 0 is Other:
<br /> E. 0 ni Rubber Lined Do?Alkyd Lining E rii Epoxy Lining Di Phenolic Lining Dos Glass Lining Ooe Clay Lining
<br /> 00, unlim Prl'--'U',known Q n Other:
<br /> F. Doi Polyeti-Jonft Wrap 0 u Viny ppinr ©.c,3 Cathodic Protection r-i Unk n 0 ij_ None El oE4 Other:
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