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Official ,.egistration Form {..,,,\ ® California Water Resources Control Board Hazardous Substance Storage Statement =-.13 who Must Rae: . Fee: oe"ifein or understowkd Con •• _ -r•e..re c o:, •3:.:•Sc - .a. as'. s.-:s 'e .,,e:-.-)^-s ,wr;:.re c^'a^•s tvaf• pr-aucn ,c.can x'nea xc S2000C :r each�:ati:he v-aror• s Code section 13173, As conveners dxkmwV aw"W*8803 ata ponos ,,"Correct aro has not oxen corrected 'agoons and sumps the Ye*Now the norma ground surface level•Tues ConadenestoW. If you nave Vormat on protected 0 trade secret taws ® register A tank sitting On n're 1pOun0 K rqt rnUuOed CPreav+ers Ggoony please attach a kst of the,Mormakon on trns form mat rs conkdernha m and e oeneath the surface are-n outted Uned or unlined pits.ponds Ono lagoons lusta"Catfdn for contodentialittvwicilvckrig specific citations of r are covered A earth has oxen rempveft from rix storage arae Io construct toryR,C,rant statu- the ,sfakiy Normal gnaong,s not C*ns,dened ComuuCtron 000w ground Mu el case taw Kvcx tdapM FM ro o+I aQ one form and reeve,t gena on sit me Oednidotk Oil Any Ei�starKa ksled m Sectbn 6382 remerrong forms Anach aM forms logefhe securely If you own more then 25316 of the HN of me Lataor Code or n SectioHealth,and Safety Code TMs 50 larks you can fee NPrnnatron on computer tape CO 916 324•1262 for ,nCludell gasoline dres � nef Ras oustrial sdfvert4 pesticides herb c oes ThisWdoris qn rept a►ental and fumigants If the mal"must*e Canned Dy a re9EterN7 ha Wer pis- Tela b Aa Underground Tanks ora Pre sutkfact!0 mnn posed of at a hl2arodus waste site;s eRwosfve generates Pressure due to local regulation Some iwisoctrons nave already oegun programs Check most or decomposition Or would harm hurnam Of wdwe you mot regsior with your ndce county government for further mformatwn ® NoTL• ALL{ AGROUND CONTAINEAS MUST RSGISTER SV[N IF STAT[AND/OA LOCAL FSRMITS ARE IN FORM I Owner wnw,caMV~„ra wer>.�.afrcr� - U. v n 91'"Ae®eru C.h �! Zia ® 1223 BroadwAy Oakland. u Faces swr.oases frf k cren skew Corral Hollow Road I-580 styco,.w z» ® South of Trac SanJoe uin w.fo r. Post Office Box 808 Livermore Ca 94550 415 422-5174 Do,artaor Ve tede Furvi Station cRoa Omer Test Facility v.ew«w Tikwit 39 a rw sear, Run/Ares ra.w.e nage shear a+r• T3S ME III 24 Hour Entiargency Cwftd Person Dan w.ri tree wen.rm w Raw.,aea c:aef; ogre ww,w,,w m-a,oro Maw.on Cris Gonzalez, Mar orae 415 422-5174 ShaMy, John 415 422-7333 COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER IV Oeserips" eew.ra ft..e.",.ra..,,o,+,.-rir assq,�.•. ® A Clo,Tank O as Sump O as Lagoon.Pit or Pond O a Other 815- 1D 8 ManutaGtxer(d awopnate) Year M Mfg_ C Year inswea. 1959 O Unknown D Container Capacityl LM gas" O Unknown E. Container Repairs'13 or None O os Unknown O ria Yes Year F is Container uerendy used 9)o, Yes Do No If No.year W last use O o3 Unknown ® G Does the Container Store(Check One) O o,Waste 16 at Product - H Does the Cv%ww StoreakbrerArMttfe-Fuel or Waste Od) Oto, Yes Oa NO If Yes.Check appropriate battles) O w Unteaded Ota Regular O as Premium (No.Diesel O os Waste 0d O x Other(Usn V Container Consitrucillon ® A Thickness of PnmaryContafnment O Gauge Cinches O cm )t7 Unknown 8 O o,Vaulted(Located in an underground Vaud l td oa Non vaulted O o3 Unknown C O a,Double Walled 2 02 Single Walled 0.3 Lined Il a Wrapped O as Unknown O x None O (Y:.•Carton Steel O o2 Stainless Steel O)3 Fiberglass O of Polyvinyl Chloride O y Concrete O:a Aluminum O o2 Steel Clad O-A Bronze O 39 Composite O,o Non-metallic O Earthen Walls O 2 Unknown O i Other E O Rubber Lined 0:z Alkyd lining O 2 Epoxy lining O Phenolic Lining 0 -Glass Lining O 6 C:av Lining oro,Unlined O u Unknown O.9 Other ® F O Polyethlene Wrap O•1 Vinyl Wrapping O 1 Cathodic Protection O Unknown O -None Ex -Omer TarWra ped i