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VI Piping <br /> A. Associated Piping: I[Xlr Above Ground G o2 Underground G w Vaulted <br /> B. Underground Piping: Dol Gravily D o2 Pressure YE]03 Suction ❑ox Unknown <br /> C. Piping Repairs: M, None G 02 Unknown Doi Yes, Year of most recent repair: <br /> VII Leak Detection <br /> Doi Visual 1:102 Stock Inventory Goa Tile Drain Do. Vapor Sniff Wells G os Sensor Instrument <br /> G m Ground Water Monitoring Wells D or Pressure Test G or Internal Inspection Ow None <br /> Dur 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 /> molly paloutlr Ch.mlul D.Na u.e Commacar Name Ills.acidamn.t paper In more/Dort <br /> Stored Staed LAs.III MnOwnl <br /> Dor ❑02 <br /> Don D02 <br /> Dor D02 <br /> ❑01 ❑0] <br /> ❑or ❑02 <br /> Dor ❑nt <br /> Dor D02 <br /> Gor CI 02 <br /> Dor 0 <br /> Dor 002 <br /> Dor ❑02 <br /> Gm C3 02 <br /> Dor Got <br /> Is Container located on an Agricultural Farm? G or Yes 0.z No <br /> IX IMPORTANT[ Read instructions before signing: <br /> Signature: The form must be signed by if 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 lank(s)are located.21 a general partner proprietor,or 3)a principal executive officer. <br /> ranking elected official or aulhodzed representative of a public agency. <br /> This form has been completed under the penally of perjury and.to the best of my knowledge.Is Ime and correct. <br /> Dale <br /> s mail.. <br /> Guee R � ✓�� April 11, 1986 <br /> PnNed Name Imc Pnone w/area code <br /> Vince R. Parman Station Manager (209) 982-1031 <br /> Send check to: Hazardous Substance Storage Statement,Slate Water Resources Control Board. P.O. Box 100, Sacramento.CA 95801 0100 <br /> P4•NM Firy sw"c 'x Pnun.w�anv code <br /> Vince R Parman (209) 982-1031 <br /> For additional forme or more Information call 916/324-1262 <br /> FOR STATE USE ONLY <br /> to Numbs !ccounMg Number Lounly N..b., <br /> ese Hecc+ve0 ❑ur I]u2 003 <br /> a4 31697 <br />