|
Official Registration Form
<br /> California water Resources Control Board
<br /> Hazardous Substance Storage Statement
<br /> Who Must File: Larii parson Storing h a ZRICIC)Us SIAIDS1,i III any under- the lank Wistics aie included.
<br /> giow I,]ccinlaln,!i must file Ihis form no ld�of IdIll July I.198d(Alter 0clolo4r
<br /> Fee: For each lank regisloTed a 1,310 140 must he paid, eX('('Pj Ltv-il retail
<br /> 1 1084 and no Wei illan Xviijziry 1. 1985 lor larrhs used on imr-ins) gas6lino stations pay $5 per lank
<br /> Definition of Underground Containers: Thr; 1,-IA, in ,cuncicle
<br /> Iriks or ofliw iindergrooncl rGnlairiPr,.-,' (Water Information. you can be fined up to $20.000 lor each day the information is
<br /> GLATIP:S, rionvauilcd 1r]Ur'C"of I, Penalties., For failure 10 file.the penalty is$500-SS 000 per day, 11 you [,-jIsIfy
<br /> Code section 131 72) All cinnininers including eaith,2n walled pija. pearls. incorreol and I)o,,; not tie.eil coli
<br /> lagoons and sLjnlps. lhaI are hclow the iicinnal ground SwMcC level must
<br /> 1egisiic,r A t;3riv sitting On IIIII ground is not included. CormmcTs partially Confidentiality: 11 YOU have, inlounatit)n O'DIMCd, by lrad(' GeC�el IFIvvS.
<br /> N2or 2alh life surface loo, irrIU-JCd 1-iined or unlined pils, poncis aric.1 lagoons please Hlla0 a list of the intormallOn on INS forn,Mal is conlidenlial 111c,
<br /> aIL C014+,'I`0j It Cann has5U®rn Feiriloved hiciro Ine storage a103 IQ construct hist licalion for cmilid(aniialay, Inclucling spec:ij]c citations of relevant stalo-
<br /> lhc! facJity Normal giadinq is not consiclorecl cansti bLkarar ground lory and (-.ase law.
<br /> I e ve 1. Mulliple Containers: Fill I and Il nn one-torm and ieave it plank on all mo
<br /> Definition of Hazardous Substance; Any substance lisled in Section 6382- (Cinaining forms. Allach all latrins logethor securn]V It you ovin more than
<br /> of mH Labor Ccxie or in Section 25316 of III FleailJi and Safety Code This 50 tanks you can file infoiination on computer lapo. Call 916/324-1262 for
<br /> includes' gasoline. diesel Inel all JI1djStIIaJ solvents, pesticides, herbicides information.
<br /> ,and lumigants 11 the material must be carried by a lr,.Igistored hauler, dis- This is not a Permit Application. Ah Underground Tmiks will 00 subjucl to
<br /> poslud of at a hn,7,irrJoLis wasic,site.is explosive. generates pressure dLJU Is local regulation, Sorne JUIISOCIOIFIS have already begun programs, Check
<br /> Iwat or lj,"Ciiul rr would harm humans or vvildl:le you must register wish your local County government for lUrlhor information.
<br /> NOTE: ALL UNDERGROUND CON' 'HERS MUST REGISTER EVEN IF STATE AND/OF -rCAL PERMITS ARE IN FORCE.
<br /> I Owner
<br /> Nxw.-iCori,,i,ftion hj,,d-ii i,r P,Adic AgeT)cyn
<br /> StOek -Inc1 0542-0
<br /> Spc,ji AJOIe',S —1 C.Iy Slate 7.1 P
<br /> 4447 X. "on Lt---J U-)p Stockton
<br /> o oc� L Cad
<br /> 11 Facility
<br /> F,Ir,LIy A,ini, Dcwi�.r, ucinan,Supra visa
<br /> Stockton Nissan Monte Johnson
<br /> '31r a.A A,1,1r0,5
<br /> 1847 N. Wilson Ray ZradfoTd
<br /> City IP
<br /> ---- �95205
<br /> Stockton �San JoLquiLn
<br /> Cily 5;310 Z
<br /> P. 0. Box 8850 Stockton Ca 95208
<br /> Friona w .uca"'W. Fypp of Business
<br /> (209) 948-9027 Doi Motor' VePiicleFuel Station E-k" Of tier:
<br /> Numh,r M f�vhs-31 Iniq F,imiil, Rural AreasRaopil
<br /> I III 24-Ho-ur.Eiiiergenc y—Con!tact-Per�son—.—
<br /> Da,s Nam, jast rarnu losq and ilii�rw,witinvu cow N19`11S.Name(14SI mini_111 rl I and Mono corm;
<br /> Ja te. 202-948-9027 Johnson. Monge _.f.209) 957-267Z
<br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH-CONTAINER
<br /> IV Description
<br /> Con,ainer Numoor kii iliurtf,is vb un-
<br /> A. V/�,, k 0 02 Surnp D o3 Lagoon, Pit or Pond 0 04 Other:
<br /> 8 Mankifaclurcr (if appiopiale): —rL)-P—'------ Year of Mfg J.ANAL- C. Year lnstalledD Unknown
<br /> D Container Capacity a�- Ions 0 Unknown I E. Container Repairs: E OT Nohe Xlo2 Unknown 0 as Yes Year:
<br /> F. is Container Ciimnfly used? PZ/pi Yes 0:-? No If Nor year of last use: 0 o3 Unknown
<br /> G. Does the Container Store (Cl One): E or Waste oz
<br /> P--TP duct
<br /> H. Does the Contiiiner Store Motor Vehicle l or Waste Olt? SKYes Ow No It Yes Check appfopriale box(es):
<br /> 0, Unieaded 0 o2 Regular 0 v3 Premium 'E kw Diesel 0 o5 Waste Oil D(r Otlier (List):
<br /> V Container Construction
<br /> A. Thickness of-Prllrnar'y Containment: 0 Gauge 0 Inches 0 cm eUnknown
<br /> i
<br /> B. 0 ci Vaulled (Located in an underground Vault.) 0 02 Non-vaulted -0- Jinknown
<br /> C. 001 Dculjlc Wallet! -0 t2 Single Wafted C w Lined 0 as Wrapped D inknown 0 or None
<br /> D. El n, Carton Steel D o2 Stainless Steel 0 03 Fiberglass D(A Polyvinyl Chloride C 05 Concrele 0 o6 Alurnlrfi
<br /> �17 Steel Clad 0 qii Bronze 0 cD Composite 0 io Non-metallic 0 II Earlhen Walls
<br /> Joknown 0 1, other:
<br /> E. Dol Rubber Lined 0 nz Alkyd Lining 0 n2 Epoxy Lining 0 04 Phenolic Lining Dos Glass Lining El o,i Clay Lining
<br /> Oo, Unlim t; h nknown 0 119 Other
<br /> F El vi Polveili Wrap 0 iv Vinyl' ping 0 tt3 Cathodic Protection eK. Unkr,,� 0 o5 None Om Other:
<br />
|