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r <br /> VI Piping - <br /> A. Associated Piping'. Dr,Above Ground 13o2 Underground 0 m Vaulted <br /> B. Underground Piping: ®or Gravity 0 o2 Pressure b m Suction 0 w Unknown <br /> C. Piping Repairs'. X7or None 002 Unknown Dot Yes,Year of most recent repair: <br /> VII Leak Detection <br /> 0 or Visual 47 w Stock Inventory 0 m Tile Drain 0 w Vapor Sniff Wells 0 or Sensor Instrument <br /> 0 m Ground Water Monitoring Wells 0 m Pressure Test 0 of Internal Inspection 0 of None <br /> 0 m Other', <br /> VIII CMmlul Compoeltlon of Metedele Currently or ProWouely Stored In Underground Containers <br /> n ypu checke0 yes to IV-H you are no required to complete this section. <br /> uw.ux /u ea.mo-r po rvw use cwnmercurvame luu aam�ma wcer iw mwe rmm� <br /> SaeC ur,w.1ee CBS.I., <br /> 0m 00 <br /> ❑o. 0. <br /> ❑Cr ❑ot <br /> ❑Or ❑N <br /> ❑Oi DW <br /> Doi 00 <br /> Dor Dot <br /> Dar Doe <br /> Dor 0m <br /> Doi oro <br /> Doi 0m <br /> ❑o. Dot <br /> Dor Dot <br /> Is Container located on an Agricultural Farm? D or Yes [3,No <br /> IX IMPORTANTI Read instructions before signing: <br /> literature;The form must be signed by t I a principal executive officer at the level of vice-president or by an aumwrzed representative.The representative <br /> must be responsive for the overall operation of the facility where the tanks)are located 21 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 beeen completed under the Penalty ofperjuryand 10 the best of my knowledgeis true and correct <br /> s�.GO/�CG� �H L`r0 Lt o>r6 S. BrS <br /> bK <br /> Pmre.�ar acme <br /> R. EEANGELISTI ENVIRONMENTAL ENG. 713-552-8732 <br /> Sena cheek to: Hazardous Subslence Storage Statement State Water Resources Control Board.P.O.Box 100,Sacramento.CA 95801-0100 <br /> 'yon"i'1 <br /> $iaiemeni PMne ry area[We <br /> R. Evan elisti, Sr. Environmental Engineer 713-552-8732 <br /> For additional forma or more Information"II 916/924-/262 <br /> FOR STATE USE ONLY <br /> �P v�me., nccw�u..a h�mm awn¢rvvm0er <br /> one am�.eaa oar em 000 <br /> 84 31677 <br />