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VI Plpi <br /> ♦ A Associated Piping 0o+Above Ground (L0:Underground 0c Vaulted <br /> ✓✓ <br /> i <br /> B Underground Ptping IN o.Gravity O ce Pressure em Suction Ow Unknown <br /> C Piping Repairs O o1 None f+q W Unknown O o3 Yes.Year of most recent repair <br /> VII Leak petoctIoon <br /> e Visual e.Stock Inventory O ox Tde Dram O oe Vapor Sniff Wells O in Sensor Instrument <br /> O ob Ground Water Monitoring Wells �J or Pressure Test O re Internal Inspection so None <br /> I.7 w Other Tan k Go,-se <br /> VIII Chemical Compwklon of Materials Currently or Pnatdonsly Stored In Un8erground Containers <br /> 11 you checked yes 10 iV-M you ore not repuneo to Complete this section <br /> COUW DO Hw the Comm�wwee tuae waoorrm�own ro mine rtxte+� <br /> wtxlC warty CAS s tk tnwamt <br /> 001 002 <br /> 001 002 <br /> 00, Doe <br /> 00, OW <br /> 00, OW <br /> 00, OW <br /> 0C OW <br /> Oo 0W <br /> Oor OW <br /> Or ❑W <br /> ❑o� ❑W <br /> 13 OW <br /> is Container located on an Agricultural Fermi Do-Yes PJ n2 No <br /> IX IMPORTANTI Read instructions before signing <br /> Signature:The form must be signed by 1)a principal executive officer at the level or v ce-president or 0y ar.authorized representative The represe"1a•ve <br /> must be responsible for the overeli operation of the facildy where the lank(s)are located 21 a genera',panne,propheto' or 31 a prmopa-execu'we o":c' <br /> ranking elected ohtctal or authored representative of a public agency <br /> This <br /> form has been completed under the ponaay Of perjury and.to the best of my knowledge is true ano correct <br /> $V wee Dam <br /> JUN 2 5 04* <br /> Rtlaw wine Tem F',—.area core <br /> T. F. OEM 5T* R. 4t -54 <br /> fkead cheek se: Huardous Substance Storage Statement Slate Water Resources Control 80810 P 0 Box 100 Sacramento CA 95801.0100 <br /> .nor 1."p sui.ewu a,o<r,. <br /> `—`415. 13 2 3- 98 2 1 <br /> E <br /> kpIEL, <br /> Corrections made by <br /> For addltlonal fano or news brilormabon cab 91 1462 LBM Corp. 10-16-86 <br /> amen Eider, RE14600 <br /> FOR STATE USE ONLY <br /> tp h�rrl0e' ACCOrMW"Q N.Rnpn . ...gip.. <br /> bore fwcwwo or O W .- <br />