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VI Piping _ -- A, Associated Piping: Mot Above Ground 002 Underground 0 .I Vaulted 8. Underground Piping: Doi Gravity 0 o2 Pressure IN In Suction 0 o, Unknown C. Piping Repairs: it of None 0 o2 Unknown D 03 Yes, Year of most recent repair: -- VII Leak Defection Doi Visual M 02 Stock Inventory 0 o3 Tile Drain 0 o4 Vapor Sniff Wells D os Sensor Inshument 0 a Ground Water Monitoring Wells p or Pressure Test ❑oe Internal Inspection p 10 None p to Other: --- ----- VIII Chemical Composition of Materials Currently or Previously Stored In Underground Containers If you checked yes to IV-H you are not required to complele this section ..Olin lr pgYlpOtlr Chemkrl 00 NW Use Commxicw Name IUse ad.LLOnal 11arx11a mac luoml SIUetl 1101,,0 CAS a 111 kllo'Mlt pot 002 pot pot pot pox pot put pot pat pot pox Dos 002 ❑01 002 ❑01 pox 001 ❑02 Dot pot pot pot pot Cl 02 Is Container located on an Agricultural Farm? ]Doi Yes Cl 02 No IX IMPORTANTI Read instructions before signing: Signature: The form must be signed by 1)a principal executive officer at the level of vice president or by an authorized representalive The representative must be responsible for the overall operation of the facility where the enk(s)are located 2)a general partner proprietor,or 3)a principal executive officer ranking elected official or alllhorized representative of a public agency. This form has been completed under the penally of perjury and.to the best of my knowledge.is true and correct. s gnalae April 11, 1986 Ltu Purred Name Tnic Station PnonO wrzlnacone Vince R. Parman Manager (209) 982-1031 Send check to: Hazardous Substance Storage Statement, Stale Water Resources Control Board. P.O. Box 100, Sacramento. CA 95801-0100 P,,Oion F9mo aiatem,,m Pnunn w aura onf0 Vince R. Parman — 209) 982-1031 For additional forms or more Information call 916/324-1262 FOR STATE USE ONLY 10 Numner Accounwo NumOn Cmm,Nnmhcr bele Recaved ❑o1 ❑O2 ❑n! B4 31697