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Official ;gistration Form , ornia Wates Resources Control Soard Hazes s Substance Storage Statement Who Must Fde: Fee: oe6ni6on of underground Containers- !;:z -- Penalties: 4.na:, .a, —cs ^on.a_ ec^jt ec tanks cr o rice•^o tic cora, es were, mor anon you can ore ed o'c 5200C^'cr sac^city rhe nidi^a on s Code section 131731 All containers.mcival earthen waited pts.ponds incorrect and has not been corrected g 'lagoons and sumpsthat are below the normal ground surface level must Cle"odearliMl If you have Information protected 0 trade secret laws. # register A tank sitting an the ground Is not Included. Containers partially, pleas attach a list of me Information on this form mat is confidential and the beneath the surface are included.Uned or unnned este,ponos and lagoorfs tustnicatton to conhoennakry.including spaclfro citations of relevant statu- are covered it earth res been removed from the storage area to construct tory and case law the facility Normal grating is to considered construction below ground � MdYpN ConfaMrs:teFill I and Id of one twin and leave rt sank On all me evM e,,eftlon o/Na Any substance fisted,n Section 6362 temafrMg forms.Attach pre toms together seCWelY a you own more man Delfirof the Laoor Code or n Section 25316 of the Health and Satoty Code.This 50 tames you can hies information on computer tape Call 916 32a•1262,ror rtcludes gasoline diesel fuel.all industrial solvents.Pesticides.herbicides tiOn ThisIs and turn, ants n l the material mil ore carneo by a registered mauler dis-posed of at a hazardous waste site is explosive generates pressure due to local regulation Some tunsorctrons have already begun programs Check neat or decomposition or would harm humans or wilate you must register with Your local County,govarntnent for furtmer information NOTE:ALL uNOEROROUNo cONTiumvila mus'r REOIsm EVEN aP STATE AND/OR LOCAL PERMrris ARE aN POnCEL I Owner _ Ne ro ieaoaepa rro.wr«a.,M Aell U.S. Government - Dept. of Energy, San Francisco 0 erations Office �tpr a Ca, 4rN z�P 1333 Broadway Oakland Ca 94612 II Fee" Pea.,fwgii. ca , Lawrence Livermore National Laboratory - Site 300 1 Don Smith sk.n.ac.e. Plow=dies$rw Corral Hollow Road I-580 ON c"" zip South of Tracy San Joaquin sial Ag eii, Ct, sloe zip Post Office Box 808 Livermore Ca 94550 P"".,«ee coos I Triw 0 dkiwi®e 415 422-5174 prat MotorVehicle Fuel Stow 16at other: Test Facility =Frew«rfq.�«m a Pearn Mia*Areae Toon= MPPsrbwt 3 cow. T3S ME III 24 Hai Ensergairviy Contact Person am hare I w isirw".ane Area».,we cam .IIr w ",«w prwiv.erne fen Gonzalez, Marjorie 415 422-5174 irry. John 415 422-7333 COMPLOE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER IV Description CakYMaee pales re.Isis.s ro hums«as.vrr ales A.Xo of Tank O ora Sump ❑as Lagoon.Pit or Pod o as Omer. 74-IID B Manufacturer(if appropriate): Year of Mfg.: C. Year Instaged Q Unknown 0 Container Capacity: 5� gallons O Unknown E. Container Rebell 43 of None O as Unknown O ora Yes Year F Is Container Currentty used? O of Yes 11l ora NO If No.yearcit last use: 1984 O os Unknown G. Ones the Container Store(Check One): O of Waste di ora Product H Does the Container Stere uef or Waste Oil? 91 oI Yes O ora No If Yes.Check appropnate box(es1: O or Unleaded O at Regular O in Premium di o.Diesm O as waste Oil O os Other(Usti V C4Mt@ifW C0111111111`111111011101111 A Thickness of Primary Containment O Gauge O Inches O cm 12 Unknown B O oI Vaulted(Located in an underground Vault.) 10 or Non-vaulted O os Unknown C O or Double Walled M of Single Walked O oa Uned 12 o.Wrapped 0 os Unknown 0 as None 0 Clo,Carbon Steel O u Stainless Steel 0 pro Fiberglass O oa Polyvinyl Chloride O os Concrete O oe Aluminum O or Steel Clad O a Bronze O o9 Composite O,o Non-metallic O I Earthen Walls C,2 Unknown O Other' E 0 Rubber Lined O:2 Alkyd Lining 0.3 Epoxy Lining 0.,Phenolic Lining 0 ii Glass Lining 0,6 Clay Lining CXR,Unlined O:s Unknown O.9 Other F O:, Polyethtene wrap 0u Vinyl Wrapping 0=o Cathodic Protection 0 Unknown O.,None IC1 ,other TarWragped