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Official rieatstratton Form C4111Water Resources Contra!®oar® Hazardous Substance Storage Statement Who Mual rift - DekrAvain W U Coniefnsim 're a•. aco•es _ c•e!e Patfussam!•or:azure o are the oenaty.s i3Z-C-55 COC cef Cay ;you•aiwv ii�rnos nonvauxea ouneo tans or ):ne, .nCergrovmo:yna.ners Aater nformauon You can De aneo up to 520000 for eacn aav the mformarron IS cote section 131 731 All garnets -rKlLang eamnen was"pis ponos ncotKf ano nes nor Deem COft@C OC agoons ana sumps mat are Dv Ow the normal ground surrace,eve,must C n you nave oto*mat on paetreo D�!ror 7e secret taws oegster t un stung on tme ground a not lin ruaea DoCZ,ras and oanoxv please artacn a list tit ime information on mus form malt a Coro o ono me D@neaten the sonata are rncttaae0 4nea o uNrrneo ars DOnOf and Ugoons ustification to contwereuwY.invuoN Spercific citations of r are coverer it eamn has been removes from me storage area!O construct 4tQvanf flifu• -le faumNormal ormil greotrp is not cons,ae ea construction ormOw aOUM !Ory ino case law eves Mkdspe Cauraffingi Fru n I ams 11 O One form Ana leave it o1 punk as the DefiniUm M Me :Anv substance osteo m r Section 6362 remt:ining forms AllaC"aft forms togehi sec Wn eit you own more man DT me Laoof Cooe Of in Section 25316 U the Meana aro Soren Cone Ths 50 norms you can tae information on computer tape Call 916'324.1262 for ncluces gasoane chaser rues as insusirlal mvemis vieshcroes merorcroe4 niormAi om and fumigants if the meterlal must De CAmg, iec Dv a reSterea Mauler ars. This M nota All UnCertrouno Tanks wnl cre suoteLi to posed of at a nazaldous waste site is exD osne generates oressure Ove!o .Ocal regulation Some vissrciroms nave alreaoY Dequn programs Check '+ear or aecompostlron or would harm humans or w,rpkle You must register &,in your focal County government for funnier informalion NOTE' ALL UNDERGROUND CONTAIMMS RPAT ARGIST1111111 EVEN W STATE ANO/OR LOCAL PERWTS ARE IN FORM Owneir �aAw�Laoa.sroe,.^xrvm,+r m ii? Ag- U.S. Government - Dept. of Ener San Francisc 0er tin Office Arsov Arwses C.y 1333 BroadwayOakland 4 1 II F fgf:ry rrreN bwo,frxsrrmn,S.pNo Lawrence Liverwgre National Laboratory - Site 3 ODon Smith Aran Amen r+rr Coax-sot w Corral Hollow Road co cpm zip South of Tracy San Joaquin Qua"AM— cn 9r "PPost Office Box 808 iy r a %550 415 422-5174 ❑if,Motor vehicle Fuel Station 11 m other Test Faei 1 i ty rM-rrr.r Try M fti FxGOr lmost Trwswrp 39 1 ator. I T3S ME 24 Hour E Qw+ i rrnw ori M xwor.,ror more Nrrw itr reroA.ore,ria .ror r�ss Gonzalez Mar ria 415 422-5174 (415) 422-Z333 COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER IV A.IR or Tarn O m Sump ❑to Lagoon.N or Porld O a.other. 813-11 D S. Manufacturer(t tee Year of MPg.: C. Year l 1981 o Unknown D. Contatarver Capacity 3000 gallons p Unknown E. Container Repstrs:M,None O as Unknow O m Yes Year IF. Is Container currently wad? 15 Ar Yes O all No It No,gear of lass use: Do Unknown G. Does to Conform Store(Check Onel: ❑or Wage Ib m Product H. Does the Container Store k"1 or Waste OV 13 or Yes O o2 No K Yes.Check appropriate box(es): p m Unleadeld O m ReguW O as Premam Qt of Dossi Q as Waste oil D as Other(U$t- V A. Thickness of Primary Containment: O Gauge O Inches p cm Q Unknown 8.O or Vakkted(Located in an underground Vaus) EI ra Non-vaufted O to Unknown C-❑a,Double Wafted M rte Single Wafted O as Lined W oil Wrapped O as Unknown ❑as None D.Q o!Carbon Sled ❑a2 Stainless Steel O it Fiberglass O o-Potmnyl Chloride O as Concrete ❑as Alununum O w Steel pad O as Bronze O as Corn Oro Noe-metallic ❑ r r Earthen Wells ❑12 Unknown (3,3 other. E.❑a,Rubber Lined ❑u Alkyd Lining O a Epoxy Lining O a Phenolic Leung O as Glass Luang p as pay Uning IZo,Unlined O as Unknown O as Other. 1 F.❑at Poly ethteneWrap O o2 Vinyl Wrapping ❑as Cathodic Protection O o-Unknown O m None TarWra ped Q oa Other 1-1