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_ VI Piping law <br /> A. Associated Ptpng C.,Above Ground Q Underground O7 vaulted <br /> S. Underground Piping O o,Gravity O m Pressure a Suction O a Unknown <br /> C Piling Repairs: Q o,None O o2 Unknown O m Yes.Year of most recent repair. <br /> VII Lads Deteetlon <br /> O m visual ER or Stock Inventory O w Tile Dram O a Vapor Sniff Wells O m Sensor Instrument <br /> O as Ground Water Mormonng Wells O or Pressure Test O as Internal Inspection O a.None <br /> [3,o Outer: <br /> VIII Chfn�kCComposition <br /> m to iv iN you are aMaterial ed O Comie��eirseclix�y Stoned In Underground Containers <br /> if Cnaa,Mes oo Nar use „mecw Nerve ealues mow cepa,a,mme nem„ <br /> tip US•m•no..n, <br /> Oa, 7Pw Diesel <br /> On, •Ow <br /> Om Oat <br /> Oa, ❑a2 <br /> Om Ooz - <br /> Oa Oat <br /> Om O a <br /> Om Ow <br /> Oa Ow <br /> 0i Ow <br /> CID ❑a2 <br /> Om Oat iJ <br /> Do, Car <br /> Is Container located on an Agricultural Farm? O a,Yes Min No <br /> IX IMPORTANTI Read instructions before signing: <br /> Signature:The form must be signea by i j a principal executive officer at the level of vice-presl0ent or by an authorized representative The representative <br /> must De responsible for me overall operation of the lacday wnere the lankjsl are locatea 21 a general partner proprietor or 31 a principal executive officer. <br /> ranking elected official or aulhol representative of a public agency <br /> This form has peen comoleted unoer the penally of perjury and.t0 Ine best of my kno'.Heageis true and correct <br /> Dale <br /> 6/27/84 <br /> r.aea a� anager, 1.all cme <br /> Klaus Ernst Plant Services (415) 422-4867 <br /> Send Cheek to Hazareous Substance Storage Statement.State Water Resources Control Board.P 0 Box 100.Sacramento.CA 95801-0100 <br /> Richard K. Henry �(415)a423-3641 <br /> For additional forms or more Information call 916/324-1262 <br /> FOR STATE USE ONLY — <br /> - 84 31642 <br /> 1 <br />