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f <br /> ,Y <br /> ,,;iated Piping: Cot Above Ground CrbQnderground °ai Vaulted' a <br /> d.Underground Piping: Cot Gravity °in Pressure -13e,Suction Do. Unknown <br /> C. Piping Repairs. None °oa Unknown °o,Yes. Year of most recent repair: ---- <br /> VII. Leak Detection ' <br /> °of Visual Stock Inventory °o•t Tile Drain ❑u.Vapor Sniff Wells ❑1✓.Sensor Instrument <br /> ❑td Ground Water Monitoring W011s On: Prc/sure Test ❑-w internal Inspection ❑m Norio <br /> °to Other: <br /> VIII Chemical Composition of Materials Currently cr Previously Stored in Underground Containers <br /> II you cheCketl <br /> Vest,IV-H yoU are not requited to compiele this sochon. <br /> L <br /> ��• Orealeek,, Chanidl 1),No,tl>e(::ynmAani Ndn'r nlsr M(IIII ai ON'la rrwrc room <br /> Ai: -eloraU slnWt GAS a lit krWw'n1 �_— __ �.:•! <br /> Ow <br /> K .. <br /> �yH;r'nl ❑4' I I rt <br /> yn.N�.. II I I 1 I II II II I _I 1� <br /> ❑ut ❑tq <br /> —LLL1 1 LLL —LL—_._ ..v <br /> t1`. .. <br /> °Oi ❑N <br /> 00, 002 - <br /> " . <br /> Owoui ow <br /> L-- <br /> I I I I H--_Ll1_I.LL..--- ----- <br /> I.1. 1 ----------.-__-- <br /> 1J�1.�1 L-Li----------- <br /> , <br /> 7. is Container located on an Agricultural fail Jy�• Yes F1 • No <br /> IX IMPORTANTI Read instructions I -tore sign:n(j. <br /> Signature:The form must he signed by I I a principal exrt:ullve officer at Ito k:vo of vire pi mkinni ul by an nuthorued representative.The representative <br /> ?.must be respunsible Inv the ovriall operaLon nt the facilq when-il',e tank,S)are Iortand 2)a geneial p;auier ptopnelor,or 3)a principal executive officer. <br /> ahking eloclua ollicwl or aolhoired rrpne.waulrve nl a public agancy <br /> form has been completed undor Ito punaily of Iwritxy and, It;Ihr h."SI of my knowledqu is Inm Aed CU((CCI - <br /> r ',�. r l :.'„'•( � ” 7 • � 2� 928/84 r- <br /> 4Prwp1 W nn 1 N WxxtP 111!110.cWC <br /> David T. Price, Inc. Pres. 209-465-34o5 <br /> David T_Price— - ---- ---- <br /> -.Send check to: Havardow.Suh•.tam.t-Sh I i p• bi.nclw lit ',iaa W.J.I conoid Thune. I'U no, too. Sacramento. CA 95801 0100 <br /> s09fmg <br /> rn <br /> kt <br /> David <br /> l,. <br /> avid T, Price -- - --- ----- - ----- —� 209-465-3405 I � <br /> 1262ll 916/324 <br /> ti <br /> f <br /> I � <br /> additional forms or more Information ca - r, <br /> � <br /> FOR STATE USE ONLY <br /> 84 31697 <br />