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<br /> f " STATE USE ONLY
<br /> San Joaquin County 06'1 Sectit,sa ,U N n ��Q+1 10.Number
<br /> ` Department of Healttl _ 3 t
<br /> P.O. BOX 2009 ��y1/IRQNMEN I AL HEALTH C)ateReceivec
<br /> Stockton, CA 95201 T/SER`dIGEs
<br /> EFRMINotification is required by Federal taw for all underground tanks that have been 4. pipeline laetlatic,[including gathering ling) regulatd under file Xatunl Gas
<br /> used to store regulad subuance,since lanuu� 1,1971,that are in the ground as of pipchnc.Saten Act of 19M.of the l lazardnu,Liquid fipehne Salta Act all 1T)
<br /> 9 ,ar
<br /> }ta,8.t9$b.or that are brought into use afar Sta,8,1986.The information requested uhtch i,an intra,tat:pipeline la<thq«guuated under.State iu%%%.
<br /> is required by Section 9002o(theResource Coneer%ationand Recovery Act-(RCRA), 5.surface impoundments.pit,.ponds-titiacnum:
<br /> 1s amended. 6.storm w "
<br /> water tit wale water collection, lcm%:
<br /> 7.flow-througd„
<br /> h prolank,:
<br /> Thcprimarcpurpose ofthis nunlicauunprogram ntolocate and c,aluateunder- 8.liquid trap,ora„tutateduthcringline,direetllrelated it)adoram,produotonand
<br /> ground tanks that ,tort car hate stored netmicum ter hazardous substances. It t, Fathering operation,.
<br /> expected that the information sou pra,idc uill be based on reasonably wai(able 9_ storage tank, situated in an underground area (such a, a ha,emcnt, cellar.
<br /> record,.or,in the absence of such«cno
<br /> rd+., ur know Icdge.bchcf.or recollection. mineWarking.drift.,haft.or tunnel)it the,tcaracc tank t,saw«d upon or ahose the
<br /> Who Aust Notify Section 9W2 of RCRA.as amended. requires that, unless surface of the floor.
<br /> esemplco.owners of underground tank,toot store rcgutatcd subslanec.%must notify
<br /> What Substances Are Co,ered' Thr notification reuu[remert,appl% to undcr-
<br /> dcla) in
<br /> State or lanai agencies at tilt aceexit rice of their tanks-mbmer means— round storage tanks that contain regulated substances.This include,am substance
<br /> broug(a) rat the ase of r t at datundcre.
<br /> n% elonge tank in tax on Nground r S. 1984,or defined as hazardous in xenon 101 (14) of the Comnrchcrosna: Ecnironmental
<br /> used for into%tome use ter that date.am person u atcdIna su s a ccs.a round storage tank Response.Compensationand Liabilitc Act of 1980(CERCLA).uah theexcr mtiun tit
<br /> used for the stora¢e.use.or dupen,ine of rcguiatcd substances.and P
<br /> (b) in the case of any undererouna,toner tank in use before`o%cmber 8. 1984, those substances regulated as hazardous came under Subtitle C of RCRA.It also
<br /> but no longer m use on that date.any racoon who ouncd such tank immcatateiy before includes petroicum.e.¢..crude ail or any fraction thereof which 1%liquid at tandard
<br /> the discontinuation of its use. conditions of temoerature and pressure t60 degreesFahrenheit and 14.7 pound,per
<br /> Khat Tanks Are Included' Underground storage tank is defined as any one or square inchabsolutu.
<br /> combmation ct tanks that i 11 is used to contain an accumulation of'regulated sub- 'Where To Notify' Compieted notifiation forms shouW be sent to the address
<br /> stances. and(2)%hose eoiume(inctudineconneaca unacrground piping)is 1017r.or gisen at the top of this page.
<br /> more txreatn the ground.Some examotes are unacrgrouna links storm¢:1.gasoline.
<br /> When To Notify' 1.Ou nen of underground storage tank,in use car that lute been
<br /> used ods or diad I tad,aria 2_industrial sanents-pcsuaces_herbicides or fumigants. -
<br /> taken out of operation after January I.1974,but still in the ground.must,lotus bs
<br /> What Tanks Are Excluded' Tanks rernosca from the ground are not subject to Mav 8.1986.2.Owners ono bring undcrgtound stora¢t tanks loin use attn�tac 9.
<br /> notification.Other tanks exctuded from notification are 1986,must notify Within 30 da,N of bringing the tanks into usc.
<br /> I.farm orresidentialtanks of 1.100gailoaforless apaatyused forstoringmotor fuel
<br /> for noncommercial purposes: Penalties: Any owner who knowin%ly fails to notify or submits false infoanation
<br /> 2.tanks usec for stonnz ricating oil forcortsumpti%c use on the premiscs%4here stored: shaft be subject 10 It ciyii oemity not to exceed SI0,000 for each tank for which
<br /> 3.septic tants: notification as not given or for which raise information is submitted.
<br /> - - t .1 •i w•t�•i —
<br /> Please type or print in ink all items except-simarure-in Section V.This form must be completed Eor nen ( Indicate number of
<br /> location containing undergaund stone tartli EE more than S tanks are owned at this location,photocopy the I continuation sheets
<br /> -verse side.and staple continuation sheets to this form. attached
<br /> Owner Name(Corporation.fnaiviauai.Public Agency.or Other Entity)
<br /> (If same as Section 1.mark box Here❑)
<br /> Greyhound Lines , Inc. Facility Name or Company Site Identifier.asappticabte
<br /> Street AcCress
<br /> 901 Main Street, Suite 2425 Greyhound Lines , Inc.
<br /> County Street Address or State Road,as applicable
<br /> Dallas 121 S. Center Drive
<br /> City Sate ZIP Code County
<br /> Dallas Texas 75202 San Joaquin
<br /> Area Coce Phone Number City(nearest) State ZIP Code
<br /> ( 214 ) 744-6500 Stockton CA 95202
<br /> Type of Owrier (Marie all that apply(Z)
<br /> [3Current ❑ State or Lccai Gov't " Private Indicate Mark box here it tank(s)
<br /> Corporate number of are located on Lana witrim
<br /> ❑ Federal Gci t ❑ Ownership tanks at this O an Indian reservation or
<br /> C] Former ❑
<br /> (GSA facnity I.D.no. u uncertain location on otner Indian trust lands
<br /> Name(If same as Section 1,marx box nere ❑ ) Job Title Area Code Phone Numeer
<br /> !.lark box here only if this is an amended or subsecuent nolificaticn for tnls location. t.
<br /> I terrify under penalty of law that I have personally examined and am familiar with the infcrrrfation submitted in this and all a-,,aCied
<br /> documents.and that based on my inauiry of those individuals immediately resconstcle for cbtarnlno Ine mformat(on.l believe trial the
<br /> sucmlttec information is true.accurate.anc complete.
<br /> Name arc official title of owner or owner s autnertze�l rearesentative ignat Oate Ctcneo
<br /> Rita Krysinski Env. Resource Admin.
<br /> LL I 5-15-91
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