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VI Pippi <br /> A Associated Piping [:)or Above Ground 91 or Underground O o3 Vaulted <br /> 8 Underground Piping RD'Gravity D or Pressure I03 Suction D a Unknown <br /> C Piping Repairs Dor None (got Unknown Doi Yes.Year o1 most recent repair <br /> VII Leak Detection <br /> eo,Visual t?!m Stock Inventory 0 to Tile Drain D o.vapor Sniff Wells D m Sensor instrument <br /> Dos Ground Water Monitoring Wells po,Pressure Test Dos Internal inspection <br /> lWro Other Ton k f2auue <br /> VIII Chemical ComnsN on of Materials Cuntsnay or Previously Stored In Underground Containers <br /> it you checked yes 10IV-H you ere not requued to complete this section <br /> ri Oreekefril' OlfwxYel po Na Uee CoPrmycw Mmr lire,0aow trop 10 mre rooms <br /> aaea taco Cis•of xroani <br /> Dor Oat <br /> Om pot <br /> Dor Dor <br /> Do- 0 <br /> D o, D 02 <br /> Do, Doe <br /> Do, or <br /> Do, 002 <br /> ❑o� Da <br /> Do, Doe <br /> Dc� 002 <br /> Do, 002 <br /> Do, 002 <br /> Is Container located on an Agricultural farm? Do-Yes W02 No <br /> IX IMPORTANTI Read instructions before signing <br /> alenatum:The loan must be signed by 1)a principal executive officer at the level of vice-president of by an auinonzed representative The representative <br /> must be responsible for the overall operation of the facility where the lank(s)are located 2)a general partner proprietor.or 3)a prmcipai executive mtrer <br /> ranking elected official or authorized representative of a public agency <br /> This form has Deen Completed under the penalty of perµey and.to the beat of my knowledgeis true ano correct <br /> spneiure �� <br /> �- JUN 0 5 1984 <br /> Wrt'aeo Mme Tae <br /> Phone sties cooe <br /> Dist. Staff Mqr. 415-542-0612 <br /> SOW cheek to: Hazardous Substance Storage Statement State Water Resources Control Board P 0 Box 100 Sacramento.CA 95801-01(X <br /> F11 P iwy-,siaanrre Phone.yea:— <br /> 415- 823- 9621 - <br /> �15 542 6?5"0- <br /> Corrections made by <br /> For additional lams or tie Information Call 916/524-/T82 LME Corp. 10-16-86 <br /> e0,A,-- <br /> James Elder, RE14600 <br /> FOR STATE USE ONLY <br /> :.surer N�rnDy <br /> Diu Mca+eo O 0, 02 c o3 <br /> t <br /> �i- <br />