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�Y California Water Resources Control Board fiwv
<br /> Hazardous Substance Storage Statement "
<br /> Who Must File: Each person storing hazardous substances in any under- the tank Wastes aro mcg tletl.
<br /> >r :,ground container must rile this farm no later than July 1, 1984(Alter October Fee: For each tank i ePpnaly
<br /> �190.4 and no later than January 1. 1985 for tanks used on terms) 9 � °T►F +�' cept that retail
<br /> ;Defiraldon of Underground Containers: The law applies to "concrete gasoline statio �/nonvauited buried tanks or other underground containers." (Water Penalties: FYr failure lot Is$500-$5.0 ay.It you falsllyCodo'seclion 13173) Alf ronlmnrm, including barlhen walled pits. ponds. information. ou can.beo$20.000 for each da a information is
<br /> .•.''lageons and sumps. Ihat are below the normal ground Soriano Invel must incorrect and has not been borf 4 l tl
<br /> .. �'regisler. A lank silting on the ground is not included. Containers partially Confidentiality: 11 you have it I li proter,a by trade secret laws.
<br /> . .,, beneath me surface are,included Lined of urMvxf pits.ponds and lagoons please allach a list of the information on this form that is confidential and the
<br /> aro covered it earth has been removed Iron the, storage arca to conslrucl luslificalinn for conlidonusENViROAJhACsWALc III@gpM of relevant slalu
<br /> the facility Normal grading is not considered con ilruelmn below ground fury and case law PERMIT/SERVICES
<br /> > level, .. Multiple Containers: fill I and 11 on one form and leave it blank on all the
<br /> r f
<br /> Definition of Hanrdous Substance: Any .utra.mco I,slyd if,Sochun 6016., rumaming Ionics Atlm if ar lorms logolher securely. If you own more than
<br /> `'el the Labe Godo or in Seerini";)316 nl the Health and Salnty Code. Tlus SO tanks you ran file mL mnaaon on rompulel tape Call 916/324-I262 for
<br /> includes: gasoline. diesel fuel. ;ill ulduslunl SnWonls. pUllo,,W s, horbu 'nfor enlion
<br /> q and fumigants. If the materiel must be yarned by a rngislarcd haute ihS. This Is not a Permit Application. All Underground Tanks will be subject ro
<br /> posed of at a hazardous waste site.is explosive.gonealcs pressure,due to local regulation. Some rrrisdlclions have already begun programs Checv
<br /> fi:..hear or decomposition of would harm humans Or wildlife gnu roust regi:Ibr with your Iona) county tlovomuienl for luilher information.
<br /> "k• NOTE: ALL UNDERGROUND CONTAINERS MUST REGISTER EVEN IF STATE AND/OR LOCAL PERMITS ARE IN FORCE.
<br /> ii
<br /> Ce
<br /> I Owner
<br /> `�r: Norma ICarearaan.IMv.tlaii a PupMc Aaariryl
<br /> David T. Price, Inc.
<br /> �.. cnv
<br /> 21657 Dodds Road _ — Escalon Ca. 95320
<br /> II Facility - -
<br /> faulaY Narro
<br /> David T. Price, Inc. David T. Price, Pres.
<br /> '��� Sten AQtara
<br /> N.:aesi Gm'Stran
<br /> CAY Same
<br /> §�•" Crrrxx. Tiv
<br /> Same San Joaquin
<br /> ' Mar4p A.iap: ---- -
<br /> i"�' scale, ZIP
<br /> l:uea
<br /> 216 9 Dodds Road Escalon Ca. 95320
<br /> wi r .
<br /> ivm .n u,r.rr,s.:
<br /> ' 20 -46 — 0 ❑"' Motor Vehicle Fuel Station R,i? Other:_ — -
<br /> DNxnv..+ r:,nhs.n iMn rac,wv Rural Areas
<br /> Only: Samm�
<br /> III 24 Hour Emergency Contact Person
<br /> L'
<br /> Will N.nYP,,]•+M1lun.
<br /> y vy•••. H.r^n'r.n.' ,nr. ru Ar.:nq I•Mrx " n....r r o.y.
<br /> Price, David 209-465-3405 Price, David 209-465-3405
<br /> 4l
<br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER
<br /> k,:IV Description
<br /> -
<br /> Tank ❑'n Sump ❑c, Laguon'Pit or L'nnd ❑rr llllnn Conttlnar umMr n nrrr, ,., ,vxn•ns a<am,•n y
<br /> _ 8
<br /> B Manufacturer (it appropriate): 1�F�f>� ri m of 1,41ry
<br /> — ! • O C Year Installed: —_-0 Unknown : .`..
<br /> contain,r Ca tut
<br /> px y: ZI d01.a y:dlnnc CI Unkn„wn I f u u unto Hop an-Cl/r Nnni• El Unknown Crri Yrs Year.
<br /> F._Is Container currently used? n Yue ❑r,.' No If Nn. year of lasl use
<br /> ___ __ _ .. ------ ------ - -. ❑ire Unknown .
<br /> G Does the Container Store(Check One): CI OI Water Producl
<br /> �H .Doo, the Container Stole Motor VOI,an Fool no Waste oil" f],r, Yr,, L-I No It Yes Check appropriate box(es):
<br /> Do, lL ilaa.ded4. Rryullr W;Ist : 7d 7,.. ihrr
<br /> (IJs11... `-
<br /> Container Construction '
<br /> -
<br /> A. Thu knr , of Primary !unl:uninr'i u. �0 �;, up• I I Jni h yr I I ,.ri ❑ llnknawn -----_
<br /> vim" -
<br /> 1- ❑,r, Vaulted (Lnrab;d man undr.tgtnlnd Vic 11 Rllnknuwn
<br /> JC' N"i. v.ullN:cl
<br /> - / i_I .r
<br /> G Of, Double Walled �u Snur• Walled Li Luu:d ].. yyrfpp,>il LL" Unknown 0,., None
<br /> 5:-
<br /> C D."C y Carbon Steel ❑ra•Slanh:ss Steal Il Flbotillar e I 1 " Pnip,myl ChInodu C Concrete C w.Aluminum
<br /> °e O n,Steel Clad ❑,x, Bronze ❑rr.Conipua le ❑ Non molail i; ❑ .r Earthen Walls
<br /> `
<br /> 13,2 Unknown O n Other
<br /> E. ❑.r. Rubber Lined Citi Alkyd Lining I1 Fpoxv Luuny ❑ +i Phenolic. Linugl ❑r:. Glass Lining ❑.x;Clay Lining '
<br /> �• Unlined O M, Unknown 13 Olhut
<br /> F.-Dai Polyelhlene Wrap C.: Vinyl Wrapping ❑," Cal4udlc Pintuchwi ?`T__ Unknown
<br /> ❑ None . 13 Othcr -
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