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VI Piping <br /> A. Associated Piping; ❑o€ Above Ground o2 Underground It o3 Vaulted <br /> 8. Underground Piping: ❑of Gravity jrl ox Pressure [Xo3 Suction ❑w Unknown <br /> C. Piping Repairs: [I of None O os Unknown ❑03 Yes, Year of most recent repair: —. <br /> VII Leak Detection <br /> ❑o+ Visual ❑02 Stock Inventory ❑o3 Tile Drain ❑oa Vapor Snifi Wells ❑os Sensor Instrument <br /> ❑oe Ground Water Monitoring Wells ❑07 Pressure Test Moa Internal Inspection ❑oa None <br /> ❑to Other <br /> VIII Chemical Composition of Materials Currenffy or Previously Stored In Underground Containers <br /> If you checked yes to IV-H you are not required to complete this section. <br /> turIgo Ayr prevlouor Chemical Do No€Use commercial Name )Use addi€ionai paper kx more room) <br /> eared Stored CAS It(H known) <br /> Doi 002 ONLY RAIN WATER USUALLY. <br /> cot 0 0 r IF WE HAVE A LEAK,- <br /> Doi <br /> EAK,❑a 002 POTASSIUM CYANIDE <br /> ❑01 ❑e2 POTASSIUM SILVER CYANIDE <br /> Doi 002 SODIUM CHLORIDE <br /> ❑01 002 SODIUM CYANIDE <br /> ❑In 002 - SODIUM HYDROXIDE <br /> ❑0i 0 0 CUPROUS CYANIDE <br /> ❑o€ ❑02 SODIUM SILICATE <br /> Doi 1302 SODIUM PHOSPHATE <br /> ❑of ❑02 SODIUM CARBONATE <br /> Dot 002 SODIUM NAPHTHALENE DI—SULPHATE <br /> ❑o+ 002 <br /> Is Container located on an Agricultural Farm? ❑o€ Yes M c2 No <br /> IX IMPORTANTI Read instructions before signing: <br /> Signature: The form must be signed by 1)a principal executive ollicer 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 tanks)are located.2)a general partnbr 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 correct. <br /> S pnature pate <br /> 1-8-86 <br /> Printed Name Tdle Phone wlarea code <br /> KAZUKI KOBAYASHI PRESIDENT (209)239-6559 <br /> Send check to: Hazardous Substance Storage Statement,State Water Resources Control Board, P.Q.Box 100, Sacramento,CA 95B01-0100 <br /> Person rit,N Sit Semenl Phone w1 area code <br /> BILL BUETTNER (209)239-6.559 <br /> For addlilonal forms or more Information calf 9161324-1262 <br /> FOR STATE USE ONLY <br /> €p Number. Accounlmg Number County Number <br /> Dale Received 001 0 02 003 <br />