Laserfiche WebLink
s VI Piping <br />A Associated Piping Oo, Above Ground !Rosi Underground ®o3 vaulted <br />8 Underground Piping lio, Gravty O of Pressure k(m Suction O a unknown <br />C Piping RepairsDo, None I& o2 Unknown 0 o Yes. Year of most recent repair <br />VII Leek Detection <br />e or visual Von Stock Inventory 0o3o3 Tde Drain O o+ vapor Sniff Wells O os Sensor Instrument <br />O os Ground Water Monitoring Wells Qo2 Pressure Test O as Internal Inspection IQ as <br />w Other rank G <br />VIII Chemical Corn aterritaft CruintnBy or Stored M Underground ConW wra <br />"M <br />Do Na UM Carxna.CW NBM IUM Mexe,W Psar a siva roW.l <br />vasa M a fa xrxf l <br />Do, <br />00 <br />Oo, <br />0 o <br />Do, <br />002 <br />Do, <br />002 <br />O o, <br />O o2 <br />Do, <br />002 <br />Do, <br />002 <br />00, <br />002 <br />00' <br />002 <br />O o,O <br />o2 <br />Oo, <br />Oto <br />Do, <br />0 o <br />��O o, <br />002 <br />Is Container located on an Agricultural Farm? Do, Yes Q o2 No <br />IX IMPORTANTI Read instructions before signing <br />tilena urs: The form must be signed by t) a pnnitapat executive officer at the level of vice-president or by an authorized representative The representative <br />must be responsible for the overall operation ofher <br />the facility we the tank(s) are located 2) a general panner proprietor. or 3) a principal executive ot,cer <br />ranking elected official or authorized representeuve of a public agency <br />This form has been completed under the penalty of perjury and. to the best of my knowledge. is true arra correct <br />Sero,ua Dae <br />JUN 0 5 1984 <br />P,exp <br />lift Pnone awes cone <br />Serb ehaek UK Hazardous Substance Storage Statement. State Water Resourbas Control Board. P.0 Box 100. Sacramento. CA 95801-0100 <br />Peron r.pq su■soWx Pura . dee arae 415 - 1323 - 9 9 z I <br />L= 415-542-15758 <br />Ra tortes or more Int ormadon oW 916/824.1262 Corrections made <br />LBM Corp. 10-16-86 <br />86 <br />�— <br />ames Elders RE14600 <br />D P..*& <br />•C ---V hx~ <br />Caps• Nurrba+ <br />om t <br />o o, <br />m <br />003 <br />D <br />