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V1 Pipinp <br /> A Associated Piping Oo,Above Ground j9o:Underground O o;Vaulted <br /> B Underground Piping ;to,Gravity O it Pressure Riot Suction O o.Unknown <br /> C Piping Repairs Ooi None AQo2 unknown Ow Yes.Year o1 most recent repair <br /> VII Luk Detection <br /> eD.visual S7 w Stock inventory O w Tile Drain O a Vapor Sniff Wells O ob Sensor Instrument <br /> O lid Ground Water Monitoring Wells t(o>Pressure Test Oa Internal Inspection <br /> 0--N— <br /> e,o Other "T`onI(..,the <br /> VIII Chemical Com,:," n of Mollodala Curranfly or Prariously Stored In Unberpround Contolnere <br /> it you checked es to IV-M you are nal teouired to comptele this section <br /> �rre^aI O�YY Do ria Yee Camiwcsi acme rVee moa:WPa b more roan; <br /> orae- aaeo (:0.S a rn.rown� <br /> Oo, Om <br /> Oo, Om <br /> Oo, Oa <br /> Oci 002 <br /> Oo, 002 <br /> Oo• 002 <br /> Oo� 002 <br /> 0, O c2 <br /> Oo 002 <br /> Oo, 002 <br /> Or Oa <br /> O. 002 <br /> —0, 0- <br /> ed <br /> , ❑02ed on an Agricultural Farm) O or Yes )I re No <br /> IX IMPORTANT! Read instructions before signing <br /> ilonature:The form must be signed by 1)a principal executive officer at the level of vice-president or or a-tionorizea representative The representative <br /> must be responsible for the overall operation of the facility where the tankts)are located 21 a genera.panne,proprietor or 31 a principal executive&.:e! <br /> ranking elected official or authorized representative of a public agency <br /> This form has been completed under the penalty of perfury and to the best of my knowledge is true and correct <br /> Je aJUN 25 W <br /> Prnxeo home l.xf Prone w Yea cone <br /> D' S -S .2-OCtla <br /> Barre ehmk to: Hazardous Substance Storage Statement.State Water Resources Controi Board PO Box 100 Sacramento CA 95801.0100 <br /> Pe,la renp yaeme.0 PnJ.e w.•,•:_ 415- BZ 3 - 982 f <br /> S <br /> Corrections made by <br /> Fa additional forma a more Inflortinterillon call 916/324-1262 LBME Corp. 10-16-86 <br /> AJI.es' <br /> Elder, RE14600 <br /> FOR STATE USE ONLY <br /> t)h�de' i1CtPWe.nG Ndmoe' ,. .- .r <br /> Dae kece,eeo pe G' .. <br />