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VI Plpin <br /> A Associated Piping Do,Above Ground pra Underground O m Vaulted <br /> B Underground Piping pfo,Gravity D of Pressure o o)Suction O or Unknown <br /> C Piping Repairs Dor None pith Unknown Ow Yes.Year of most recent repair <br /> VII Leak Detectlon <br /> Quo:Visual tow Stock Inventory 0 boo Tile Drain O oe vapor Sniff Wells O of Sensor Instrument <br /> D as Ground Water Monitoring Wells o or Pressure Test Doe Internal Inspection 0;so NeFt <br /> IT'-Other 'Tunit GnJuE <br /> VIII Chemical Composition of Materials Currently or P Stored In Underground Containers <br /> It you checked yes to IV-H you are not required to complete this section <br /> 11—Mr •ado Ca a«M po Fur sae Commrr w Rome lucre aomoNe Pave as more room <br /> «deo VKX- CAS.Iv.—I <br /> Dor Dol <br /> Oo, Om <br /> 0 o Om <br /> O o, Dot <br /> Dor Oat <br /> 00, D of <br /> Om Ow <br /> Oo. Dot <br /> Oo, 0 0 <br /> Oo' 0 0 <br /> (Doi O of <br /> Do Oat <br /> O--, o <br /> Om <br /> Is Container located on an Agricultural Farm? Do,Yes 102 No <br /> IX IMPORTANTI Read Instructions before signing. <br /> "riatum:The tam must be signed by 1 I a principal executive officer at the level of vlce•prestdenl or oy ar,authorized representative The representative <br /> must be responsible for the overall operation of the faciiny where the tank(s)are located?i a genera:panne,proprietor or 31 a princ,paj e.ecuove once- <br /> ranking etected 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 /> 5". as. UN 25 <br /> Fmrea Name 1«e Pnpnr w«ea[me <br /> —r F S M6k. L(IS—GL12—Qcela <br /> tlhn!Cheek se: Hazardous Substance Storage Statement.State Water Resources Control Boaro PO Box 100 Sacramento,CA 95KI.0100 <br /> Pe•aan F.ns 5,«em«r: PnJnr.I- <br /> cit: 4 I rj- S 2 3- 9e2-I <br /> Corrections made by <br /> For addlUonel forms or awn kNormation to 9%W4-1262 LBME Corp. 10-16-86 <br /> James Eider, RE14600 <br /> FOR STATE USE ONLY <br /> n)N.mPer Kewm•np NWnor :.a.•'.•..—.ce <br /> b«e aecavec Doi- <br /> I' <br />