Laserfiche WebLink
VI Piping NO PIPING <br /> A. Associated Piping: [Jot Above Ground ❑o2 Underground ,J as Vaulted <br /> B. Underground Piping: ❑of Gravity ❑oz Pressure ❑03 Suction ❑o4 Unknown <br /> C. Piping Repairs: ❑of None ©o2 Unknown ❑03 YeS, Year of most recent repair: — <br /> VII Leak Detection <br /> ❑of Visual ❑02 Stock Inventory ❑o3 Tile Drain ❑o.Vapor Sniff Wells ❑os Sensor Instrument <br /> ❑o0 Ground Water Monitoring Wells ❑o>• Pressure Test KI oe Internal Inspection [Jog None <br /> ❑so Other: <br /> VIII Chemical Composition of Materials Currently or Previously Stored In Underground Containers <br /> If you checked yes to IV-H you are not required to complete this section. <br /> Wri�ntl� pr"—sy Ch*mksl Do Nof Use Commerval Name (Use additional paper for more room) <br /> stored stowed CAS It pr Nnown) <br /> ❑of ❑02 <br /> J. I I I I I I I I I NO WASTE USUALLY <br /> ❑or ❑,az ! <br /> 1101 ❑02 <br /> IF WE HAVE LEAK "SULFURIC ACID" . <br /> D 0 ❑02 <br /> ❑of 0 C <br /> Doi ❑02 <br /> Doi ❑02 <br /> EJ of ❑02 <br /> ❑of ❑02 <br /> 0701 ❑02 <br /> 0 o El 02 <br /> ❑01 ❑02 <br /> ❑o1 0 C <br /> Is Container located on an Agricultural Farm? ❑of Yes 602 No <br /> IX IMPORTANTI Read instructions before signing: <br /> Signature:The form must be signed by 1)a principal executive officer at the level of vice-president or by an authorized representative.The representative <br /> must be responsible for the overall operation of the facility where the tank(s)are located.2)a general parinbr proprietor,or 3)a principal executive officer, <br /> ranking elected official or authorized representative of a public agency. <br /> This form has been completed under the penalty of perjury and,to the best of my knowledge,is true and r..nrrect. <br /> Signature Date <br /> • I-8-86 <br /> 7KAZUe TAte Phone wlarea code <br /> KI <br /> KOBAYASHI PRESIDENT (209)239-6559 <br /> Send check to: Hazardous Substance Storage Statement,State Water Resources Control Board, P.O. Box 100.Sacramento, CA 95801-0100 <br /> Person Filing statementwfarea code <br /> Phone <br /> BILL BUETTNER (209)239-6559 <br /> For additional forms or more Information call 916/324-1262 <br /> FOR STATE USE ONLY <br /> to Number: Accounting Numoer: County Number: <br /> ❑ate Received: C]01 ❑32 0 03 <br />