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1 f , <br /> VI Piping <br /> A. Associated Piping: ❑o, Above Ground oz Underground El*.3Vaulted <br /> B. Underground Piping: ❑of Gravity ❑e2 Pressure eI JljCtloo ❑o< Unknown <br /> C. Piping Repairs: & Nont� ❑02 Unknown G e:, Yes, Year of most recent repair. <br /> VII Leak Detection <br /> ❑of Visual ❑oz Stock inventory ❑03 Tile Drain ❑o. Vapor Sniff Welts ❑os Sensor Instrument <br /> ❑oe Ground Water Monitoring Wells or Pressure Test 0 na Internal Inspection ❑-A None <br /> ❑to Other -------- — ---- - ---- -- —_ _— <br /> VIII Chemical Composition of Materials Currently or Previously Stored In Underground Containers <br /> li you checked yes to IV--H you erre not required to Complete this section <br /> curl pr"Oulliq GM IAIMW no Not Use Cummr cla;haf 0e adal'onal paper for more room) <br /> stored slorCd CAS it SII knows,) <br /> Doi 0n2 t <br /> o t ❑02 <br /> ❑o, ❑oz �L_L�tL�-Doi ❑C:: l_ I I <br /> ❑o, ❑02 <br /> D or ID 02 <br /> Out D 0 <br /> EI as El or, <br /> C]nt ❑az I I � I I I � I f I � - _ _ <br /> D 0 ❑oz <br /> ❑01 D 02 LLLLLL H <br /> °it I1Illll <br /> Is Container located on an Agricultural Farm? ❑of Yeas 2-111"No <br /> IX IMPORTANTI Read instructions belore signing: <br /> Signature: The lorm must be signed by i I a pnncipaE executive officer at the level of vire-president or by an authorized representative.The representative <br /> must be responsible for the overall operation of the facility whore lhrr tank(s)are located..2)a general partnLlr proprietor,or 3)a principal executive olilcer, <br /> ranking elected official or authorized representative of a public agency <br /> This loom has been compleled under the penalty of perjury and.to the bo-sl of my knowledge, Is lrue and correct. <br /> S�nalurei Dale <br /> Plfinen Name Tllw Pnone w/al ea C4oe <br /> Send check to: Hazardous Substance Storage Statement,State Water Resources Control Board, IDD Sox 100,Sacrarnenlo, CA 55801-Or 00 <br /> +—Person F 4rry Slalemen, Prime w;area code �,r } <br /> �.Y► -�J 'v',nZ Z' yL��- i�V- 1., - 'fi <br /> For additional forms or more Information call 916/324-1262 <br /> FO's STATE USE ONLY <br /> ICS I w Arcuunang Nu'Y.o i County Numoer <br /> Gal@ RUCO,vam r�W,. _ ❑u2 ❑07 <br />