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`-' Official Registration Form __w California Water Resources Control Board Hazardous Substance Storage Statement Who Must File: Each person storing hazardous substances in any under- the lank.Wastes are included. ground container must file this term no later than July 1, 1964(Aller October Fee: For each lank registered a $10 fee must be paid, except that retail 1. 1984 and no later than January I. 1985 for tanks used on farms). gasoline stations pay$5 per lank. Definition of Underground Containers: The law applies to "concrete Penalties: For failure to tile.the penally is$50045.000 per day.If you falsity sumps. nonvaulled buried lanks or other underground containers." (Water Inlorrnallon,you can be lined up to$20.000 lot each day the Information is Code section 131131 All containers. including earthen walled pits, ponds. incorrect and has not been corrected lagoons and sumps. that are below the normal ground surface level must Confidentiality: It you have information protected by trade secret laws. register. A lank silting on the ground is not included. Containers partially lease attach a list of the information on this term that is confidential and the beneath the surface are included Lined or unlined pits.ponds and lagoons uslificallon for confidentiality, including specific citations of relevant slatu. are covered if earth has been removed from the storage area to construct Ior and case law. the lacllity. Normal grading is not considered construction below ground y level, Multiple Containers: rill I and II on one term and leave it blank on all the Definition of Hazardous Substance: Any substance listed in Section 6382 remaining forms. Attach all terms together securely. If you own more than of the Labor Code or in Section 25316 of the Health and Safely Code.This 50 tanks you can lila information on computer tape. Call 916/324-12621or includes: gasoline:diesel lues. all industrial solvents. pesticides. herbicides inlormalion and fumigants tl the material must be carried by a registered hauler,dis- This Is not a Permit Application. All Underground Tanks will be subject to posed of at a hazardous waste site.is explosive.generates pressure due to local regulation. Some jurisdictions have already begun programs Check heal or decomposition or would harm humans or wildlife you must register with your local county government to(further inlormalion. NOTE: ALL UNDERGROUND CONTAINERS MUST REGISTER EVEN IF STATE AND/OR LOCAL PERMITS ARE IN FORCE. I Owner Name IC.p.9mn InNmeual a Puehc Agency) UNION CARBIDE CORPORATION $Ved Ad.sf Cdy Stale ZIP Old Ridgebury Road Danbury CT. 1 06817 II Facility FaGdy Name De11.11F.emaa/supenisot Union Carbide Ag Products Co. , Inc. Vince R. Parman Nem.sl GOas sheet Sheet Atilt Austin Road Coy caunly ZIP Manteca, Ca. San Joaquin 95336 Madmg Aa.ess car sial. LIP R.R. 1 Box 10144 Manteca CA. 95336 Phone.tale.code Type of eusn.is (209) 982-1031 ❑N Motor Vehicle Fuel Station Mz Other: Research_Farm b al __ Nhm.uv d TanIns FacndYRural Areas Toemsnp Range Setlmn 3 Only: III 24 Hour Emergency Contact Person bayf Nam.pass nems Ih91 ane Plan..,.,a.Code Nryhls Name pall name 1.91 and Phos.w.area Cale V.R. Parma. 209 982-10 1 209 823-5574 COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER DIESEL TANK IV Description conblmr NumWY III Invu a no mann! ass.,n.,It A.%)in Tank 0 o Sump 0 o Lagoon, Pit or Pond 0 a Other: 2 B. Manufacturer(if appropriate): Year of Mfg: AePr2x.1978 C. Year Installed: 1978 ❑ Unknown D. Container Capacity: 350 gallons ❑ UnknownE. Container Repairs:$30l None D 11 Unknown 0 o Yes Year: F. Is Container currently used? N of Yes ❑o2 No If No.year of last use: ❑m Unknown G. Does the Container Store (Check One): ❑of Waste 8 oz Product H. Does the Container Store Motor Vehicle Fuel or Waste Oil? M 0l Yes ❑02 No It Yes, Check appropriate box(es): ❑m Unleaded ❑u Regular ❑m Premium [Xo. Diesel ❑m Wasle Oil ❑m Other(List): - - V Container Construction A. Thickness of Primary Containment: 20 IXGauge ❑ Inches ❑ cm ❑ Unknown B. ❑of Vaulted(Located in an underground Vault.) PCI oz Non-vaulted ❑1:3 Unknown C. 0 o Double Walled IN o2 Single Walled ❑w Lined 0 Wrapped 0 o Unknown ❑oe None D. ❑o. Carbon Steel I.2 Stainless Steel ❑o2 Fiberglass 0 I Polyvinyl Chloride 0 o Concrete 0 Aluminum 0 o Steel Clad 0 o Bronze 0 Composite ❑to Non-metallic ❑ II Earthen Walls ❑12 Unknown ❑13 Other: E. ❑of Rubber Lined ❑02 Alkyd Lining ❑m Epoxy Lining ❑04 Phenolic Lining ❑os Glass Lining ❑os Clay Lining IXo. Unlined ❑a Unknown ❑w Other: F. Doi Polyethlene Wrap 0o2 Vinyl Wrapping 003 Cathodic Protection ❑g. Unknown 0os None - 119sal Other: -Asphe t