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VI Piping <br /> A. Associated Piping: ❑31 Above Ground EY]02 Underground ❑m Vaulted <br /> B. Underground Piping: ❑m Gravity ❑o2 Pressure X03 Suction ❑ou Unknown <br /> C. Piping Repairs: (No1 None ❑w Unknown ❑m Yes, Year of most recent repair: <br /> VII Leak Detection <br /> (Kc, Visual ❑02 Stock Inventory ❑m Tile Drain ❑od Vapor Sniff Wells ❑05 Sensor Instrument <br /> ❑m Ground Water Monitoring Wells ❑dr Pressure Test ❑oe Internal Inspection ❑os None <br /> ❑m Other. • <br /> 1 <br /> VIII Chemical Composition, of Materials Currently or Previously Stored in Underground Containers <br /> It you checked yes to 1V-H you are not required to complete this section. <br /> currently previously Chemleal Do NoUse Commeroef Na&,.addmmmal paper fdr n'orp turn <br /> ,toed zRu'd CAS v[if knownl <br /> ❑ Cl up <br /> ❑rll Cl b2 <br /> ❑01 El.2 <br /> ❑01 ❑d2 <br /> ❑o1 D0 <br /> 00 ❑02 <br /> ❑01 El 02 <br /> ❑01 F1 02 <br /> El 0, D0 <br /> ❑o1 ❑02 <br /> D ❑02 <br /> ❑Ut ❑02 <br /> ❑01 ❑02 <br /> Is Container located on an Agricultural Farm? ❑o1 Yes IXu2 No <br /> IX IMPORTANT[ Read instructions before signing: <br /> Signature: The form must be signed by 1)a principal executive officer at the level of vice-president of by an authorized representative.The representative <br /> must be 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 /> ranking elected official or authorized representative of a public agency. <br /> This form has been completed under the pen It of perjury and,to the best of my knowledgeis true and correct. <br /> Sonmo,c Data <br /> Pnmrn me 1Ale Phone w/arca code <br /> Marty D. Yoclan Vice President (209)673-7071 <br /> Send cheek to: Hazardous Substance Storage Statement.Slate Water Resources Control Board.P.O. Box 100.Sacramento,CA 95801-0100 <br /> Perspn Rimy sulemenl Phone.;area code <br /> William M. Wathen (209)673-7071 <br /> For additional forms or more information call 916/324-1262 <br /> FOR STATE USE ONLY <br /> ID Nunm,l Nun.b.,r - wooly Number <br /> Date Aem,rd ❑0I 1102 ❑O3 <br /> lw 84 316W <br />