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VI Ptpl <br /> A Associated Piping ❑m Above Ground Qro:Underground Oc:,Vaulted <br /> B Underground Piping m Gravity Ow Pressure Ow Suction Ow Unknown <br /> C Piping Repairs O o,None j9 o2 Unknown O w Yes.Year of most recent repair <br /> VII Look Detection <br /> ❑0,Visual O w Stock Inventory ❑of Tile Drain ❑w Vapor Stu"Wells O os Sensor instrument <br /> O a Ground Water Monitoring Wells O or Pressure Test O as Internal inspection X09 None <br /> O rc Omer <br /> VIII Chemical Composition of Materials Currently or Previously Stored M Underground Containers <br /> if you checked yes to IV-H you are not regwred to complete this section <br /> pevwrp (aeMsrwlO preaeM Do Na tIu eawrnprcw Name IIMC g0eaw pp0a b more r0om� <br /> snares aarro Cr+s a In xrgani <br /> Oo+ Ow <br /> ❑0, Ow <br /> 00� Ow <br /> Oo. Ow <br /> ❑0, Ow <br /> ❑m Ow <br /> 00� Ow <br /> ❑r Ow <br /> go- Ow <br /> ❑o. Ow <br /> ❑c Ow <br /> ❑u ❑w <br /> ❑or Ow <br /> Is Container located on an Agricultural Farm? Oar Yes fifOz No <br /> IX IMPORTANTI Read instructions before signing <br /> signature:The form must be signed by 1 I a principal executive officer at the levet of vrce•presroern or by ar.autnor.ted representative The representat,ee <br /> din <br /> must be responsible for the overall operation e facility where the lank(S)are located 21 a genera_partner proprietor.or 31 a prmCrpa+executive Once! <br /> ranking elected official or authorized representative of a public agency <br /> This form has been completed under the penally of perjury and.to the best Of my knowledge is true ano correct <br /> JUN 2 5 1984 <br /> pxpp0 twine Tap (� °r+orrr w«ep— <br /> .S <br /> solea cheek b: Hazardous Substance Storage Statement.State Water Resources Control Board P 0 Box 10D Sacramento.CA 95BOt•01 DO <br /> «.O r nasw.wm tom•,'.•< 415- 023- 9821 <br /> k <br /> Corrections made by <br /> For additional forms or more Infomtati®n t o 916!924-122 LBME Corp. 10-16-86 <br /> " � <br /> `/ <br /> James Elides, RE14600 <br /> FOR STATE USE ONLY <br /> w k„mor KW W.tY�NJwR" u .�-.if <br />