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Official Registration Form
<br /> CoOomla Water Rasoune Carried Doan
<br /> Hazardous Substance Storage Statement
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<br /> 1 198<an0 nn lalel Inan linuary 1 1985Inr IdMs used rel larm9l gysgnle sla4ons pry$$y('r fans a
<br /> GWYnona GMYIMIa: The Vw un RanalnaC Fol lanr,remhm 11,1nallyrs S5.0$500 pm say 11 loom,1,
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<br /> NOTE:ALL UNDERGROUND CONTAINERS MUST REGISTER EVEN IF STATE AND;ON LOCAL PERMITS ARE IN FORCE.
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<br /> 11 Facility r ---
<br /> ❑or Mda Volni Fuel Slalmn ❑m Omer _
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<br /> 111 24 Hour Emwgmty Canted final
<br /> Mervin Fetzer (209) 887-3815 Marvin Fetzer 209 931-2612
<br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER
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<br /> A 11...Tank ❑u Sump ❑✓�Lagoon PitM a PO ❑w Dlnell 2
<br /> B Manulactura Irl apaapn[aylesals Year 0 Mfq' 1980 C. Year Instanea. 1960 _❑Unkndwrl
<br /> D CalCapac9y 5,v gallons ❑Unknown E Container Repairs lam Now 0 L unknown ❑'rr Yes Year ------
<br /> F IS Container Curremly Lai Mo.Yes 0 No It No,year 0 Iasi use ❑m Ur nto
<br /> G Dan me Caaalrpr Stan Knack One). ❑or Wage Qe Product
<br /> H Dce Ire Caaimr StoreMda VENdn FUN or Wage OII? mor Yee ❑oz No II Yes Check programs poa(eal
<br /> ❑or UnleaOed Au Regular 0 x Foran Ow D1eM 0 i Wage On 0 i other(List),
<br /> V Cantdna Ca dinsEaS �'c
<br /> A Th,clarl0 Primary COnialrll
<br /> nera: 5/16 ❑Gauge V Inches ❑Cm ❑Unknown
<br /> B ❑,.Vaulle l(Located 1n an uMargouM Vai !d'.c Non-vaulted ❑a Unknown
<br /> C.❑m Douse Wi ad single Waned Om Lined 0 t Wrapped ❑.Unkrown ❑.Now
<br /> D Mr Canaan StM ❑to Sellnkss SIM ❑o F,Dmilea d ❑.Poryvinyl CNords 0 Concrete ❑ue Aluminum
<br /> 0,'”$M Card ❑.Bronze ❑+Composde ❑,o NoremNatlic ❑ rr Eadnen Walls
<br /> ❑v Unknown ❑, other
<br /> E ❑..RuDher Lme, Cl w ANYd Lining ❑w EM,Lmhlq 0.r Phenokc uning ❑v Glass Lining ❑d CMY Lining
<br /> Me,Unlined ❑N Unknown 0 o Other
<br /> F 0,r PRI,dmihe Wrap ❑w Vinyl Whipping 0 n r CalhWoo Promat 0m Unknown 0m Now Aw other TAR
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