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fated Piping: ❑rf+ Above Ground Underground ❑o3 Vaulted <br /> Underground Piping: ❑or Gravity ❑oz Pressure a Suction ❑o+ Unknown <br /> C. Piping Repairs: one 0 o Unknown 0 n Yes, Year of most recent repair: .____—_— -- -,x <br /> VII Leak Detection <br /> ❑or Visual Stock Inventory ❑w Tile Drain ❑im Vapor Sniff Wells ❑or,Sensor Instrument <br /> 221 <br /> s Ove GrourxLWater Monitoring Wells ❑or Pressure Test ❑w Internal Inspection ❑+ None <br /> n <br /> ❑o Other. <br /> VIII Chemical Composition of Materlals Currently or Previously Stored In Underground Containers <br /> II you checked yes to IV-H you are not required to complete this suction. <br /> CyrrNlFj p�.radarM ChM IC4-'00 N01 Usr CI..&CItl NI ajw aOWaonal pare+for mae rWI,r$ <br /> Woroo $1.1d CAS.for It.1 <br /> ❑0f ❑w <br /> t' � _— <br /> a <br /> x--1l LLLI H -1 11 --- <br /> ' Our Oaf —'=--- <br /> ,. lr' <br /> ❑:r_ _ll__1_L1 <br /> Do+ .Ore :Y« <br /> CI of ` 0W <br /> .001 ow <br /> Ll <br /> 1J_ . ----------__–.— <br /> { . 71 1_.1111--1--1 .1. 1 1 _LL_ ----- - -- --- <br /> °�+ ° .•_ III 111 J._1 J_1 _L l L..--------__ _-- �;; <br /> > 'o <br /> 1I LL11111L.1. 11 - - - - --- -- -- _. . <br /> __J- H 111I_I 111.-LL___.-- <br /> 7s Container lueaud on an Agricultural Faun? Yrs ❑ No Y <br /> IX IMPORTANT1 Read instructions holure signmq <br /> Signature: The form must be signod by 1)d prnfnpal dxmU,hrc nlhref oft fhr lova!+d vfrr pwNifient or by an authorized representative. The representative <br /> be'responsfbk:for the ovmall otrofabrnf ul the lankly xnera thn!:aura an''x d1.•n ,)a(iI partner proprietor.or 3)a principal executive officer, <br /> Tanking elected official or authorized repmsenlalwe of a puller agrnr.y <br /> his form has heron completed under the Irasill;of pegwy and it,ar•i+n';! n' my knowtudgu IS Iroe and Correct. <br /> David T. Price, Inc. b'we P::o w'arcaen0c <br /> David T. _Price -----. .—_.- _ _.--- ._ ._ Pres_-_.-- 209-465-341 '4 <br /> h <br /> Send Senceck to: Hatardwi:.Su1+;a:mrc Sunup; Scnunxru blue Watrf Hv' uun�••: t <br /> r:urxod keml 110 Hux to0. SacramentCA 95801 0100 <br /> o. <br /> a4. ��P.. <br /> David T. Price -,--- -209-465-3405 I ^, <br /> m, f <br /> -> .For•addilional forma or more Information call 916/324-1262 <br /> FOR STATE USE ONLY -5 <br /> ---- --- _ 1 --'- -- - - ---- -- '+ <br /> `/ `/ 84 31697 <br />