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Official Registration Form California Watar Resources Control Board r Hazardous Substance Storage Statement Who Must Rte:Each person storing h32ardous substances in any under- the lank,Wastes are included. ground container must tole this form no later Than July 1,1984(After October Fee. For each lank registered 8$10 tee must be paid,except that retail 1,1984 and no tater than January 1.1985 for larks used On fili gasoline stations pay$5 per tank. sumps. Oauue�wleand Conks roan,ther Tlaw applies to sc(WB l Pew-For failure to lite.the penalty Is 5500-S5.0W per day.It you tall undergroundWormalion.you can be fined up to S24.000 for each day Me informatfon is Code section 13113) All containers.Including eanhen walled pitsr ponds. incorrect and has not been corrected. lagoons and sumps,that are below the normal ground surface level must register A lank &h,ng on the ground is not included. Containers partially CorHldentlall .. If you have information protected by trade secret laws- benealh the surface are included Lined or unlined plls.ponds and lagoons please attach a liV Of the information on this form that is ConllQenhal and the are covered it earth has been removed from the storage area to construct justification for conlldenhalrty.Including specific creations of relevant statu- the facility, Normal grading is not considered construction below ground tory and case law. level. Multiple Containers:Fill 1 and 11 on one form and leave it blank on all the DNlnition of Hazardous Substance:Any substance listed In Section 6382 remaining forms.Attach all forms together securely,11 you awn more than of the Labor Code or In Section 25316 of the Health and Safety Code.This 50 tanks you can file Information on computer tape.Gail 9161324.1262 for includes.gasolinediesel fuel,all Industrial So{vents,pesticides.herbicides information, and fumigants If Ire 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 In local regulation. Some lurisdiclions have already begun programs. Check Meat or decomposition or would harm humans on wildlife you must register with your local county government for further Information. NOTE: ALL UNDERGROUND CONTAINERS MUST REGISTER EVEN IF STATE ANO/OR LOCAL PERMITS ARE IN FORCE. I Owner S&T {CWlx:x nIna ,r p PU06C Al TIME OIL CO. Sum Haan! crr SlagLIP 2737 W. COMMODORE WAY SEATTLE WA 98199 II Facility Flaarq HMN QlltlilFOlEr++✓ti'il$ypAyypr TIME OIL CO HENRY J. BAILEY slew-a*"$ I Nerve Ga!Wm 3015 NAVY DR. WASHINGTON ST, CJy r.— zip STOCKTON I SAN JOAQUIN 95206 N•w Aaams, GM 9aE Lip SAME SAME SAME SAME PignE rYSi CODE ryP.CII itylnp!! - 209-462-3848 (7oi Motor Vil Fuel Station lOther PETROL" TE72MINAL Nuni6er d Tains li M.FK- I Rural Ah as T— rtm9! 4eraon 2 Only: III 24 Hour Emergency Contact Person �ar1 NaT!IIaL nlnR'ixLl iM PnranE r.dit!CO�k Ngnii Nart+C lii4 nim{.t.51i ind FTpK•r,yle!rOOR BAILEY, HENRY J. 415-232-7447 SAME COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER IV Description confMiwr rrfrlMw I n Ihno�s ria numa�i!lygi w,ei A (Rol Tank ❑oz Sump C c3 Lagoon.Pit or Pond ❑ar Other. 40 PERKINS B. Manufacturer(it appropriates: liFt DING Year of Mfg.; UNKNOWN I C, Year Installed; 1976 ❑Unknown D. Container Capacity: 4000 gallons ❑Unknown E- Container Repairs. Moi None 0 a Unknown 0 o Yes Year F. Is Container currenlly used? (No,Yes ❑o2 Na It No,year of last use: 0 o Unknown G. Does the Container Store(Check One): ❑o+waste DIm Product H. Does the Container Store Motor Venice Fuel or Waste Oil? C,oi Yes ❑o2 No If Yes.Check appropriate box(es): BLEND PREMIUM I,'d of Unleaded (Rw Regular Q 03 Premium Max Diesel C as Waste Oil M oe Other(List): GASOI TNF UNLEADED V Container Construction A Thickness of Primary Containment: 114 C Gauge M Inches ❑cm ❑Unknown B 73 a,Vaulted(Located In an underground Vault( az Nan-vaulted CO3 Unknown C. 1Z j, Double Walled Qw Single Walled ❑03 Lined O C,Wrapped ❑.s Unknown Lica None D. (go,Carbon Steel ❑oz Stainless Steel ❑c3 Fiberglass C o.Polyvinyl Chloride ❑as Concrete Coe Aluminum C Sleel Clad ❑as Bronze ❑:5 Composite C io Non-metamc ❑ ii Earthen Walls ❑i.,Unknown C,3 Other. E. C of Rubber Lined ❑02 Alkyd Lining ❑of Epoxy Lining Co,Phenolic Lining C os Glass Lining ❑oe Clay Lining la,Unlined 11 oa Unknown 0 og Other: