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VI Piping e <br /> A. Associated Piping: 0o Above Ground IRo2 Underground 000 Vaulted <br /> B. Underground Piping: 0 of Gravity 0 02 Pressure 0 m Suction M4 Unknown <br /> C. Piping Repairs: 0 of None 02 Unknown 0 oa Yes, Year of most recent repair: <br /> VII Leak Detection <br /> 0 of Visual 0 02 Stock Inventory 0 oa Tile Drain 004 Vapor Sniff Wells 0 05 Sensor Instrument <br /> 0 ce Ground Water Monitoring Wells 0 02 Pressure Test 0 os Internal Inspection 0 w None <br /> MtoOther: Unknown — <br /> VIII Chemical Composition of Materials Currently or Previously Stored in Underground Containers <br /> If you checked yes to IV-H you are not required to complete this section. <br /> currently prefdduely ClumkN Do Not Use Combi Name (use aadflonal paper for more rwml <br /> Stored sforetl CAS M fit knownl <br /> Oof 002 <br /> 0o 002 <br /> 001 002 <br /> OOf 002 <br /> (1Of 002 <br /> I <br /> 1:1 of 002 <br /> Dof 002 <br /> ❑of 002 <br /> ❑Of 002 <br /> of 002 <br /> Oof 002 LL <br /> 001 002 <br /> ro- <br /> Of 002 <br /> Is Container located on an Agricultural Farm? O m Yes ]02 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 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 parmbr 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 perjury and,to the best of my knowledge.is true and correct. <br /> 5gnafure Data <br /> 4/30/86 <br /> Fumed Name T,ne Phone w/area code <br /> C. T. TRAMMELL DIVISION MANAGER (818) 505-2400 <br /> Send check to: Hazardous Substance Storage Statement.State Water Resources Control Board, P 0 Box 100. Sacramento, CA 95801-0100 <br /> r4mdn Pvmd S:aleTenlFor additional forms or more information call 916/324-1262 <br /> FOR STATE USE ONLY <br /> ID Number Accounlmg Number County Number <br /> Data Received ❑Of ❑^2 ❑03 <br />