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VI Piping <br /> A. Associated Piping. D m Above Ground b oz Underground Dan Vaulted <br /> B. underground Piping: 91 r.Gravity 0 oz Pressure ®m Suction 0 ox Unknown <br /> C. Piping Repairs. non None 0 oz Unknown D w Yes.Year of most recent repair. <br /> VII Leek Detection <br /> Dor Visual ®oz Stock Inventory 0 m Tile Drain 0 w Vapor Sniff Wells 0 os Sensor Instrument <br /> 0 oe Ground Water Monitoring Wells 0 or Pressure Test 0 of Internal Inspection D oa None <br /> Oro Other: <br /> VIII Chemical Composition of Materials Cumngy or Previously Stored In Underground Containers <br /> II you checked yes to IV-H you are not required to complete this settlen. <br /> m„rn, w tau M a.rras.l m nor use co-�mo-o-n x,m. p:e aaamar.i wce lo-more rmrr <br /> Oreo stwM CRSn n�xnOwni <br /> Doi Dm <br /> ❑0: ❑M <br /> Dor ❑oz <br /> ❑o. ❑oz <br /> Dor Dm <br /> Dm Dav <br /> Dor ❑o: <br /> Doi Ds <br /> Do. Doz <br /> Do ❑n <br /> Orr ❑ <br /> Do 0 r, <br /> ❑a. ❑oz <br /> Is Container located on an Agricultural Farm? Do-Yes Biz No <br /> IX IMPORTANTI Read instructions before signing. <br /> Slgnslum:The form must be signed by 11 a principal executive officer at the level of vice president or by an authorized representative The representative <br /> must be responsible for the overall operation pl the facility where the lanes)are located 2)a general partner proprietor,or 3)a principal executive officer. <br /> ranking elected official or authorized representative of a public agency. <br /> Tbia farm has been completed under the penalty of perjury and,to the best of my knowledge.is true and correct. <br /> on. <br /> S•s•8[ <br /> np� cone <br /> R. EVANGELISTI SR. ENVIRONMENTAL EPG, w 713-552-8732 <br /> Send Check W: Hazardous Substance Storage Statement Slate Water Resources Control Board P.O.Box 100.Sacramento,CA 95801-0100 <br /> P4.so"nnw snemex 713-552- <br /> 1 Pw nca Evangelisti, Sr. Environmental Engineer 113-552-2— <br /> 8732 <br /> For additional forma or mon Information"it 9161324.1262 <br /> FOR STATE USE ONLY <br /> io x-.,,oe, o-,�o,.a x�-ro-. comr xumer•, <br /> oai.rmre,.00 o^ - . om <br /> 84 31697 <br />