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VI Piping <br /> A. Associated Piping: ❑of Above Ground 1Xo2 Underground IN 03 Vaulted <br /> B. Underground Piping: ❑b1 Gravity IN o2 Pressure X,3 b3 Suction ❑04 Unknown <br /> C. Piping Repairs: ;p 01 None ❑02 Unknown 0 03 Yes. Year of most recent repair: <br /> VII Leak Detection <br /> Doi Visual ❑o2 Stock Inventory O 03 Tile Drain ❑o+Vapor Sniff Wells ❑os Sensor Instrument <br /> oe Ground Water Monitoring Wells 0 a Pressure Test Mf Internal Inspection ❑og None <br /> ❑io Other. <br /> VIII Chemical Composition of Materials Currently or Previously Stored In Underground Containers <br /> II you checked yes to IV-H you are not required to complete this section. <br /> curr-lir iKavlowrI ChamkN DO Not Use Commercial NameUse add4ionat <br /> stored aped CAS a(If known) { paper far more rooml <br /> 0 0 ❑02 ONLY RAIN WATER USUALLY. <br /> El of ❑oz r <br /> IF WE HAVE LEAK, . . <br /> ❑of ❑02 <br /> SULFURIC ACID <br /> ©b, ❑ HYDROCHLORIC ACID <br /> ❑br [3 o2 <br /> CUPRIC CHLORIDE <br /> 0 o 0 0I I I I I I I IRON CHLORIDE <br /> [I DI 0 c NICKEL CHLORIDE <br /> ❑ot ❑02 <br /> 0 O 13 02 <br /> ❑ot- <br /> pox <br /> ❑ot ❑oz <br /> ❑of ❑b2 <br /> ro 7 <br /> 0 0 <br /> Is Container located on an Agricultural Farm? ❑of Yes o2 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 partnbr proprietor,or 31 a principal execulive 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 /> signature <br /> 11 Dale <br /> ' I-8-86 <br /> Primed Name 71110 Phone w/area code <br /> KAZUKI KOBAYASHI I PRESIDENT (209)239-6559 <br /> Send check yo: Hazardous Substance Storage Statement,State Water Resources Control Board, P.O. Box 100,Sacramento,CA 95841-4100 <br /> Person Filing Statement Phone w/arra code <br /> BILL BUETTNER (209)239-6559 <br /> For additional forma or more Information call 916/324-1262 <br /> FOR STATE USE ONLY <br /> 10 Number: Accounting Number. Courtly Number. <br /> Dale Received O bl ❑02 11303 <br />