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,g <br /> ,oclated Nlping: Our Above Ground MiC2Underground 0 11 Vaulted <br /> Underground Piping: ❑of Gravity O oz Pressure Suction ❑04 Unknown <br /> C. Piping Repairs: — ❑ None ❑n± Unknown ❑II,Yes Year of most recent.repalc -- — <br /> VII Leak Detection <br /> ❑o, Visual Stock Inventory O w Tile Drain ❑Nw Vapor Sniff Wells ❑o:.Sensor Instrument <br /> ❑im Ground W er Monitoring Welht ❑II, Pressole Test ❑Ila internal inspection O 110 None <br /> R O to Other: <br /> xVIII Chemical Composition of Materials Currently or Previously Stored in Underground Containers <br /> ' II you checked yes to IV-H you are not required to complete this section. <br /> cu"-ft preMprapr - cminical DU Nix(/•.P(:,vnrnpCo'N."N! IIlu:aaaNnnn Q,1{x11 IN mwa r+wnq 1i <br /> sit M - Owed G,ks a fit im.1) <br /> Out ❑ rz I I I I I <br /> ., <br /> 11 U, ❑IY( Ll I LH I <br /> 0111 ° I 1 L_LL1LL11LLL I -------------°- <br /> y°' J-11-J .1 _L-111._1 .1.1 - - ----- <br /> 11.1111-LL-- ------..___-- <br /> th <br /> ❑°+ Owll11-11 ----- <br /> Ow <br /> LLL_1_ Ll <br /> °' ❑='----111_LL_11.LL1__l_ 1_t...__. ... ._..- _ -- -- <br /> r <br /> •.1Fy <br /> l_L.L LL1__ <br /> ;+ °°' ❑`' �1 LI I Ll I I�_1__1._1_-.__.-_ _ _______.___.- �. <br /> a <br /> i <br /> - Is Container located on an Agricultural Falm'/�— � 1'' s n No <br /> g, IX IMPORTANT! Read Instructions ul:brr, s' Igruny <br /> [� `Pgnatwtr The loon must bt-stpiodby 1 I it pun,.lpal ew•,ulm•oth(,I at 1111, I 111 Va.. pu au'•ul nl by an uulhoriied tepresontalrve.The representative ._ <br /> }� 4 rnusi be responsible for the overall opetallor.ill He-lacdlty wlllllthe Idnkl`:' h i u.nlan .! :I,P'nur.d planer proprietor,of 3)a principal executive of6ref. <br /> irankinq;elected official or authorized fepreYenlldn,:'ut a p11LL- a (-n' y a? <br /> k .This term has been completed under the pull,llty of pequty .•nu III Ito: I.. '.1 lay knuwb`dyu e.nu:, and Correct Y <br /> 6 M KL. <br /> ygllwwU n.I1C 9/28/84 <br /> { N Mpl Nam,: wra,re <br /> Dnavid avid T. Price, Inc. JI Yres. 209-465-3405 <br /> ---- - - ---- -- - "I+. <br /> .;Sand check to: Hazardous Subnlance Sluruye Slatrmel'I skit.Wood tiu soun'es Conlml Boattl. P O. Box 100• Sacramento.CA 95801-0100 <br /> VtrYxt LLrel` 1'F.ixu i ,m n unlr. <br /> David T. Price 209-465-3405 <br /> R4 � <br /> for additional forms or more information call 916/324-1262 +� <br /> 3 <br /> tl� <br /> FOR STATE USE ONLY <br /> IL Nu'OGn 4 . x'••• lu I - n.na N•InIM, •' <br /> g <br /> • . 194 31647 <br /> i'- <br />