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VI Piping <br /> A. Associated Piping: °of Above Ground i3<2 Underground Dor Vaulted <br /> B Underground Piping: °or Gravity °02 Pressure ®'6a Suction ❑o< Unknown <br /> C. Piping Repairs: • iii None Do., Unknown °te Yes, Year of most recent repair: <br /> VII Leak Detection <br /> °nr Visual W o.• Stock Inventory °ria Tile Drain °o.Vapor Sniff Wells °m Sensor Instrument - <br /> °or Ground Water Monitoring Wells °of Pressure Test °oe Internal Inspection °to, None <br /> °,,Other: <br /> VIII Chemical Composition of Materials Currently or Previously Stored in Underground Containers <br /> It you checked yes to lV-H you are not required to complete this section <br /> eurrerwy prewcuoy CMnIIeY Oe Nnl LLve Crrmrnercod Nnme (Use 001W.1 pnper is more ram <br /> slant 51Ured CAS n III known) <br /> °nl ❑ria <br /> n n, 1111 � 1 � 11111 - -- — <br /> ° IIIII � IIIIIII <br /> El <br /> °'o °rll• <br /> 11 I I I I I I I I I I I <br /> ❑ I II <br /> °°rElIIIIIIIIIIIII <br /> ❑nl ❑,r, <br /> Is Container located on an Agricultural Farm? °of Yes W ro 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 he,responsible for the overall operation of the facility where the tank(s)are located 2)a general partner proprietor,or 3)a principal executive officer, <br /> reni.nn ober d olfinial or authorized representative of a public agency <br /> pL•bvl un.h , IN, pgn;lly of Pr•Iplry amt to Ru• l-.I ul my knowbldq. v. brm:ind covetd <br /> Send check to: Hazardous Substance Storage Statement.State Water Resources Control Board P.O. Box 100, Sacramento, CA 95801.01 00 <br /> Pervrn f dmp siammeni Phone wott..cW. <br /> For additional forms or more Information call 916/324-1262 I✓/ �ie�+`� 4 <br /> Ilk lG9� JAN 2 4 <br /> ENVIRUNIEfvIAL HLALTH <br /> FERMIT/SERVICES <br /> FOR STATE USE ONLY 1 <br /> �I I. n, - - _ Aruoal ry Nu e.11 -.. -I(a mly Nu Ito. <br /> bate li..n:•'il ❑pl - ❑u.l <br /> 84 31fl <br />