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VI Piping <br /> A, Associated Piping: Ool Above Ground IXo2 Underground 0o3 Vaulted <br /> B. Underground Piping: 0 m Gravity 0 02 Pressure CYo3 Suction 0 op, Unknown <br /> C. Piping Repairs: Cfor None 0 oz Unknown 0 o3 Yes, Year of most recent repair: <br /> VII Leak Detection <br /> (X0r Visual 0 02 Stock Inventory 0 o3 Tile Drain 0 04 Vapor Sniff Wells 0 os Sensor Instrument <br /> 0 o, Ground Water Monitoring Wells 0 o7 Pressure Test 0 oil Internal Inspection Cos None <br /> Did Other: <br /> r <br /> VIII Chemical Composition of Materials Currently or Previously Stored In Underground Containers <br /> It you checked yes to IV-H you are not required to complete this section. <br /> currently pnetouely Chemical Do Nu!use commecar Na a addrtmnai paper Idr more roorr <br /> ,1-1 stored CAS n Ill knowol <br /> 0", O 02 <br /> Ont ❑0z <br /> 0m On, <br /> 0 el O n <br /> ❑" 002 <br /> 0^ Cl 02 V <br /> 0nl 002 <br /> 00+ ❑n2 <br /> El P, ❑nz <br /> CI nr 1:102 <br /> Om 002 <br /> ❑ot 002 <br /> ❑or ❑0z <br /> Is Container located on an Agricultural Farm? 0 w Yes M(12 No <br /> IX IMPORTANTI Read instructions before signing: <br /> Signature: The form must be signed by 1)a principal execulive officer at the level of vice-president or 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 penalty of perjur d,to the best of my knowledge,is true and correct. <br /> Sgnamrr nam <br /> Pnoled Name Title Phone wiaree pddC <br /> Marty D. Yocum Vice President (209) 673-7071 <br /> Sand cheek lo: Hazardous Substance Storage Statement. Slate Water Resources Control Board. PO. Box 100,Sacramento. CA 95801-0100 <br /> Person FLng Statement Phone l,!arca code <br /> William Me Wathen (209)673-7071 <br /> For additional forms or more Information call 916/324-1262 <br /> FOR STATE USE ONLY <br /> Q)N.lnm°r A c...orm Numpnr COmny Number <br /> Dmo Rrre��en ❑nl ❑u2 ❑n3 <br /> 84 31697 <br />