*360E22 "

Direct questions to ZIA Information Analysis Group at 415-288-4500 .

00360 E 022

HDMSe00106345

MEMORANDUM

INTERNATIONAL EMPLOYEESROCKWELL

TO ALLROCKETDYNE DIVISIO N

E TROOP & MEISINGER

F BEENREVIEWED IN CONNECTION WITH PENDING

THIS FILE HAS

LIT-Ll-m L-r .L%Jz"OM BEHIND THIS SHEET

. IT FS FRCUMENPLEASE DO NOT REMOVE ANY DO COPIES SHOULD BE MADE ANDNEEDED ,IS FILE ISSOMETHING FROM TH ING DOCUMENTS FROM THIS FILE

.THAN REMOVRATHER

ANY NEW FILINGS SHOULD B E PLACED IN FRONT OF THIS SHEET.

K YOU FOR YOUR COOPERATION IN THIS MATTER'HANT RT

OF HILL WYNNE

PORTERFIELDIF YOU HAVE ANY QUESTIONS ,PLEASE OR CURTIS

DAVID SHAPIRO IN CORPORATE LEE LEG DAL ME ~ OOR

TROOP & MEI

AONTACT JENNIF$R TAG- F

HDMSe00106346

Official Registration For mtw Catllorrmga wow Rrsourc41 Control ford

Hazardous Substance Storage StatementNSYe Moo sea : Each perann ala,np hatuoous wouanCkh .n any uryaa W IS warues ala Incwoea

III,= cM11ur1Pr rnull IJe(nw Ipm rw later Ihan kit 1 glad l Allbl OCIUAar No'. For erCn I ►rw ,a¢Ix4'IVO a $10 1M rn<W be pa.d . .cipr trw reu0

rw6rC on larmy ir rwst e5 f Snul par lao ggiimne 1161,08 pay 1919iM1 rn0 nu u1ef lnan Jinrrr 1

p weon N WreereyOUrd ConWnM : Trw Ia . apples 10 convllr FamlYai . F V Iadure ID hit the PH1s,fv ii s50G 550(10 Per CIA, it you tallayn r fr•J `a (valor c V0000 lot e r d11 (r1CyfaGmllOn isY wi y( ,( 1lormaDftn you L-•" be hnWJ LWmP1 nIX1.•u11Ctl LwMrtl I.n .i OF Ol'V' untie,prJUnC C u

C11dk SCCI,6r 1 J17JI Al, CJrlla rntrb r .l rlO cBnhlr , wall['d WIS porltli I(ILo'r4Y1 ,n0 half not over. CUrrcCI[a

yDOO111 ana Sumps that are UHGw Irre Wormer Mauna burlnt revW nIubI 11 you ha . l vlICwmallon praected of, Iraae WWCrel IIWt,

IsQISIw A Irrw &II n~ .7n the wc .. no : 1 not ,ncl .loi a Cohtnan',1 pan,bby(araw .allri .n A 4111 of The ,ru0rrtwl .Un on Ink loin that is congeraw an o [ire

Der1Ur1n lhr NXISre d,CrnCll. d 1 111(0 Of JlWhyD PIS P0406 Brut IJQn(N16 Iuplh .llIOn roe coI-l OBMUdIy IfCIU0If9 :fSCJIC Crisuoru, Of laarvlra SIll1l-b1 l•

(he Iscddy Ntr nal Dla0jrly i5 not tons10c'Iea conbuaction oe!G' 6uOunO

M "'k lema, r.hi I(XmsAllser All I 0rm6 1OVIrkr faCrely 11 you own m(ME Iran

01 ire Lon ai 1i <a► eoua IrAlHrq/ . Any 1u -, itrF Ir- in $e INn 6382 SO lara,a you can 1" a11LOIrlre On W compulal tape CAN %W324 126: 10,

Od IFP LAD- Cone C . m Setts :S31o of it .• neann onl5 o Sarrlp Cone J r%j m1r>rnlaun

Ono 1ULIL 9.n11 111ris- alSlel ai mull De 651, 100 Ly 6 re14 1 .ilk0 hdultl 0li-

puaed at fit a nalar0 ou6 Wasik *Ie I1 a .Wu1 vi Jlfneldle5 wit'S we auc 1 0l rItlpN U

Wall Ur OKOmpolnlur DI wo1YO hr rn numdnb or watltJC fOU mul

MtiSp(? ConIMAWS : Fu, I And II On Onelorm and level J elari. on 3 6 ,nft

IOCat ,NQuialio lSothe y 5 ko,clon1 have rue5Oy DCpun proprarrtl Crle[.k

with your ICICII YDurayQr)VB1nmtnI I CH 11X(110, Inormilion

MOT! ALL VMDE11011OUND COKT A61NE11I MUSTAE01STIN EVINM ITATIF AND/0111 LOCAL KNOTS AAIIN POr1CI.

I Owner,' SI!W ICSlaa ,rn,I,n .u,+ .u r.a .c wVr`cn L .

. I~ CD, 1 uCale COreed ll etirtn oat Deer lemon t,un In. 6lo,ay+ a,(I(yy rend Cat= la w

XIC 6UOe6 oa sol.ryt G,obei k,el 6 4 ,1 .1111,5 nolellIll pe dl ,C,oen nrrolUdOS thisN PAR a ( 111It Appli caVell . Air UnoirOrountl Tanks will Des4dlecl to

ILK. W EU. GM ('ORA'n D N - EL Slrc UA1OOIr.c . r

M. ., Aayw .

90245I CAtLSECiUUDO'2Z 30 EAST LMPLr~IRL 14W !̀

II Fa cIUIy , _rKa•1 w,, .

LETDJ N t~

I wu, ~ /

w Ir

LGoa3 COrM06A P, VF- CANDGILPAiir .IL A I D4Mn .w : rwCOe. l .p a au.+,,,Y .

l 8 7 1 D L70 ❑ ,, Motol Verude Fuel Station GM otnel '

Plural Aree a

oeyr

i e.+wws.~an

III 24 Hour Emisrgency Contact Perron

IwMI a Ter. .1 .,. I",

T hKK.S

PBjTEETIVE S~IWICCS FURL OEM BtL-3i4 Z ATQ.I . Nan.r ,uu . w,w ir41 .,,u rv,uw. r i s.. mar

COMPLETE THE FOLLOWING ON ASEPARATE FORM FOR EACH CONTAINER

Clo, Tank 0 Sump $ o3 Lagoon Pi or Pond ❑ w piper

B Manufacturer (ii appropriate) Year ofMip

D Container CaWcily 31MVK lions ❑ unknow n

F. Is Container currentty useo? I Yes ❑ w No 11 No, year dl Iasi use

Def. I ,rwryn, S..or. w n

L- IV ?. CO STA$wow C. . ..sa 1 .

~t fiL -

C Year Irish ed Unknown-Ni

❑ w unknown

0 Does t ri g Container Store (CF1.Ck One) waste ❑ w Pro duct A-Ie Y- -k- TV,14r-tS 4 riy4- ( I+Zd

H Does Irla Container Store Motor Vehicle Fuel DrWasle Oil' ❑ I„ V. . No II Yes, Cheek a;ppropria(eboa( ea )

V Container Conshucllon: : ::

A Thickness ol Primary Containment ❑ Gauge . .:❑ inches ❑ cm .. :g unknow n .. .

E ❑ u, Vaulted (Located in ■n underground Vault .) "w Non-isauaad ❑ w Unknown

d ❑ u Cartwn 51ee1 ❑ a Sla ,Ness Seel ❑ us Foe; gias s ❑ Q . FOlyvnyl Chuoooe ❑ a COOcrete d ra Aluminum

E On, RuDber Uneo ❑ w Alkyd Lining ❑ m Epoxy Unlnp ❑ , Prwnokc Lirrrtp ❑ o- Glass Ltrvp Oa Clay Lift"

C UM, wno

C,- f'alvelT erw Wisp ❑

0 pine

Vir yr Wlapp , nyl C CelnJO„ PI01a 1, ❑ :,• Urwnuwn PI" N0( re ❑ A D1110, -- :

Cr..W iar •saaOM Ir .a.c a N ,q.aw .

LJ

HDMSeOO106347

A Assoc-aled Piping D, Above Ground ❑ 0 Underground ❑ u~ Veultod

Underground Pipng . y1 Gravity ❑ o. Pressure 10 of Sucti on ❑ w Unknown

C Piping Repairs ❑ , r None or Unknown ❑ v : Yes Year of most recent repair

VII Leak Detection

❑ u: ' Stock inventory ❑;,r Tile Drain 0 w VapLK SnAL Wdlls ❑ oc Sensor instrument

0 a Ground Water Mondorrrt We llS ❑ r r Pressure Test Q to internal Inspectio n

❑ , Inez: ~- --~..._~ J

VIII Cnemlcal Compoaltlon of Materlala Currerntly or Prnrloj*iy Stored In Underground Contalnert

it you chocked a lu 1V H uu ulu not Ng3vroo 10col 1 pluh um sucllun

wnp;ap 6/r.. 1.Sy ClIent (3 fi s u . . L . . N .r +.n,n. . iuw .r.... tsc p.w , , u . no+,uw~

uuw w.ra CAN • ix-1

L1 t I I I I I I I I . . c~rcrt

Oc t

❑ vr

❑ o,

❑ of

❑ or . . . . .

❑ u, Q02I. I I

is Container located on an Agricultural Farm? ❑ or Yes No

IX IMPORTANTI Read instructions before signing

pueOeleaatura : The I(Xm must be trgr1e0 Dy I'I a pr~nelpal OeACUpve dhcer al Ihe level of vice- p(as,deru or by en.au

o ,B fCUl wmuss be (elpokeble lor the overall Operation of the leCllny where Ita tanktsl are located 2) a general patindr prop/reed : or 3) 1 pr nclpal

conking elected 01 11 CI2l oraUthori0e0 raplaaenlahve ol e puDiC agenc y

This loin ,as Dean comaleaed under tree penally of paquryand . to ttlr [feet 0l my knowledge is true and correCi

reaefaar ee Tr o retfnra i

19-

Tat

ba r

Prow .• r6/ °wt "

I.nd obstlik Ito : Hazardous Substance Storage Sialemern Scale Waist Rflolucet Conlral BOerd P D Box 100 . SoCramenlo . CA 95801 -0 100

► nuw vrtr 1 cOW

r8 O0 - 7 z

For eddUonal brats or more Informaron cub 016/ 324- 126 2

F OR STATE USE ONLY

84 ]]b0l

HDMSe00106348

I 4 .n0 l4"Pf IFa1 .rr tN1 . lr%r ^1lrw - • -' v.si-CrIllYawY .Ip1' 1~ +~ h.rr 016Ima11W JIdaCIM Vy -raw 14,1;10 la +

NOW ok O Pei.; EACH 94154. slw„+q n4[MODUS t„ouJw,, rf ,n .ny ,hJQ Ir1 . L WW Ilat alr d,L.•,,J. a

m,1IormAu .&" ln .njJr I 1904 Alkn OCl,.pWYrLn Ip1.: .ieq w-wo ■ t1UISt mar at Pala t .CaplInarlaudPer FoIl, . .awrw ;- Orr .ry.mpsgrfva ~a1 .7ane 54iFM3 J4v SS l)m 'amI , ~~ :.4f rr, MF 'Man January . 19Y5 'x I .r $ +flC 7n w f

palw ema, a1 lin+Irfrarn14 Caar Fri : no 4w. a{IPr1 a COr,t I,d1. PM.afMaL F r a, gut-i,• • Iy Ina A4ay s tTJU LS JO(1 Dal Ily I V .u Ialf1y

Ito III mal,ull 4na r )lti • rYA1ar i2~ 1K1 OF U4Cn SYn )dle r_J , , n W -I, Y•+Id,*al"/~ ,J.. : ., 0 .;,,,T,0% ron . .,.ea t,-" .h.1 Or . .Mr w,A .r•gl J.

nl. w4MC0 $I JI , rCICOr 1 ro n--al rdri . 1 Ore44 f C~Jl~1 v . b ~nr: Lr, :ir .1 10,,. . . . CuO. y"JK" l Jl7]I AA C~r`14.I1W 1 .'~C

-3 ,+~bs 04aJ O, •75 /W ,JVu4l1a lu sl .t Jl .ln Id ~OnnOllMyall . f•LI .]1tI t n:I It c U(SY1S 01 'eb .ara . laluahrr1Y, Ilv .Jima .ld C'-HO t "eq :W

. . .alt =L ."gro J farln `at r."r rerk)vir illin 'n. -

4

;IO,a o J-411 t1, Jul, 4na iaSn 4 .n

Ina Jec.dy h.y 1 'r .dny 5 nor C - 11141 ri ..dn)1. aCl Ur, 3ew:w y ..on a

r ..x IIWlPat ConWn .ra "N I A1.1 II ur erne 1cvm ara ItarS 1 oar* an Ja l v

rrr1anI bl' 'Wm. AII .CI as OITS IL1 ur "L-l 1.C•,r .1y 1 yAa Jv.n more Man

tLawwn W M.Lriawa lrI . DJ I Anr :1 .514ce alga n 5 .uan 6 382 5~l lams a, Can I,w 1lI ' Slav. un CjmP.,l.l lour C4& 916, L14 I' ICI

oI r4 i .ou Ce.w a m WC,On 17 1d Of I-W r+eaan Sr.,) ia-01r C .v. 1„b ~.ar alum

MWJu,YI5 45pOhn* ].far '.C4 5a noull.yl ,,,,wrdy . Frutl,C,atf neaV-auf A4 llrsur• Duna YSnat ..4 of 96&"? toana .n„q .ns • 1 Ina • al8f ,A1 mU.l Of L .r ra t7y a r,,wclhd 4 .,I.1 As TV" Is IN" .rmrlAppYa.W.

OU147 ,r1 .1 a nar:aroul asimv l4 ,s 4s{au1 H ,IWrlk+rlty pl .s►JS 1.,! Ia Iy[41 rr$Jwul .un Salve ,s bj, lLons naoa .;4,tae, Ou Qun I)3.m$Cr,oC11

Mon Y 10+ .11 C,11, jora'vnrI I la lwlrla, .f l31 rn4I .O/1- rp, . IN- .•„31.10 ,L ,l.ab .

rural a. i.co1 po 1i . rn Or .Souk n-mm 14,RWnv -

COMPtI1 C THI FO LL OWING ON A EPMAT[ FORM FOR EACH CONTAINIEPI

IV Dsuplpron

A Tnlcknets co Pr,marrCurfalnmt.nl I l ~--C Gaup 1f)nCr111 0 Cm CUnrnow n

A ❑ a . SIUA1tl (LOC1led .n In ,x 4erfl1OUAtl Vaud) r NOn• 4 lulla ,7 C3 ~, Unknow n

CC a. Doaow Walled Slrvpa Wa5vn ❑ : L(nel Or. Wr& .d C Unilr sn ❑ )b Nor*

0 0 . . Carbon Steer 0-. rJla.rYQij SI .W ❑ iJ FinerMast C3 r Pplyvdlyl Cr.Os asI

C.i s ruin C of A)OrMWY1

C e SIMICad O a B,dur O . Compoalla C N] 1 .T tI11aC C3 Fannon WIIII

o ., Unknown a 00%W

E O ., Ru00F urlaa C .r "Id Llltrq C , Epca L WS C PYwIIOI.C L . r y C . C.LI1 Larrq ❑ a Cray Chino

uvula C a Urikncwn ❑ - pllfr _

F C V .%`wrlrnc Wrap C Yrrl JrraGm-ry. 0 C4111,4- . Plurtii :.;n C ar wn N,) s . CI'111 T

HDMSe0010634 9

all 46L1. 1JY10111 (3AOU5 CONTAINf11I MUST 11103111111 IrVIIN IF ITAtI AND/OA LOCAL PEANUTS ME IN POi1Cl .

III 24 Hour lnwrgel Coi lcl Prr~n n

Y+. .+ JT .w w ry c .,... ,dal Aew .

7 TI4N KS a1r11

C.30D ❑ ~I Motor vorwc~ Pw1 Station 5s rn71 D8n.~ . . w WON I,.i °

Orrlc,al ReglS'~atlca F' rmC/Worr" W Mf 114$ 0we se Control Goad r - !

Hazardous Substance Sloraq * z amment RS 5-7a_

I Own.r

F 2t 30 Fl4ST LMPLR. I+4L 1.4W'!

¢GCK W tU. GGlt .t'OR.P 7 D N F -L SECT U1vW

EL15EWILIVI0 C A

rr : .

S3ftLT .) NQ0 .. . I .rrm. n . I .q.. .y.

t. W .7. Co STIGrJ -r✓~

-14

L.Ga'3 C ArNO6 •P, 1104c 4JXA t'A QLL A

nx ~±r MOTDP~

y.. .. .... ur !L... 4 ., m 0w" • .n- M.p.. ~r14 Iwl. ,y.w I. . n. r a,w . rte. car

eurureVS. SEwICCS) OEM BAL-3 194 13f

C a, Tank C3 cir Sump n LapOOf Pit Of P01110 O O . Otn/+ `

BManulIClwer ( dappropnIII). Year W M0 C. Year lnetlllaw: -Ow *fbOwrl

0 ContIas t Clpa ~~00 1uIo1I C unknown E Con( nrr Rfpalrf Ca . Mons Om Unknown C a rn Yiar

F II Conla .r Sc currently 3NO ) PtIll 1=,,a NO if NO, year 011151 use '.. . . ❑ . UnYCnow n

G Don lneCon111nsc Store (Crs cs 019) if,, Waste C W PYpdt c t

H Do" If S CCnialnw Slaf Moir V,r1.c9 F'~ 4 o Waalt Oil's . . . C .. . Yes r' NO It Yes . CMtk adPrOp7.11/ 00a111 )

a• UnMaoad Car Rpuli C a Prar111Jn) C r Du e C w Waste 011 ❑ or 01nef (Liu)

V Cpsd nfr Gonuhuccllon

A Associated Piping OV,,Atove Ground For Underground ❑ u, Vaulted

D ✓ pre sure ❑ 03 Suction O w Unknow n

C Piping Rcpa is ❑ ,-None o r, Unknown IX.,Yes . Year of most recent repe l

R Underground Piping jv~ Urrv il y

VII Look Detectio n

visual ❑ yr Sroch Invcfnio y 0 T ,lc Drain 13w Vaw Sn il l Wells ❑ u, Strnsor Instrument

0 . Ground Wrier Mondonny Wells 0 r r Pressure Test ❑ Internal Inspection

❑ ,,,Othor

VIII Chemical Composition of Materlaia Currently orPrrvlo.ulrly Stored in Underground Containersit uu lhur. aee es ra .I V Ii : 'uu ~ru not r u rutl . In. r mnt lc lhla huCINJn

-- ..Ork.>rrxl y 't;.AY A (if rnown i

❑ u ,

Do,

0❑ m

D o

D o, Duo

L i

C1 SIX M1,+ l, .urI!!,-~ rh.,r~s . rLiw, MM,, u, irdW it trxv„ rwr ,

S ~ Ai r P

IIIIIIIIIIII I

III I I IIII III I

IIIIIIIIIIII I

is Conrainen Iocaled On an Agricullural Farm? ❑ )I Yes N o

IX IMPOATANTI Read rnsirucrorrs before signin g

oignaturC 7ne balm moat be s,Bnea by 1 I a prin cipal extcut vu olucer ai the level of urea-pre& der.i or by an aJlhoraed lapresenlallve The reprraetllallve

meal be responsible for 11w overall operatonul the Facility wnure Inb lark(a) are loceke0 2} r general pvrtrl (,r proprietor , or 3) ■ principal executive obrcet

tanking elected Olli C ial pr aulnOrizba repieeatil5liVe of 9 puck agency

rnis Form has coon completed under the pertly of perjury Bno . to the best of myknowWdge . is true *no correct

ouv

P,umrv Nana, Twn PIrcNw 'w' UM .. . .. . .. . .. .

Bond Chick 10: h9 :arpout 3uoslance Storage Statement &ale Warn Resources Control boero P D Box too. Sacramento CA 9580, -0100

eddltlonal lorme or more Inlormetion CM 516W324-1267

FOR STATE USE ONLYAr t,..,dry N .

HDMSe00106350

r QrhGdl Re arall o rl F,(-n

^r' •~•• Camor m wsw AreDWGN GOMid loved L -~

Hazardous Substance Storage Statamant

sra .+,q n~laraa..+ i,.puan, vs ,n rny .n~W Ina iank AriMYat4Yinr

55-.

OWN Park f&0 PrI ,9eaNh ( ILorf rd flu iM m.~1 Or Pall .s .a IAM Iriana•'auu

TINIY u mli W IV]"%,~ .I .9M arw ,u 40. ~rar Jar,rry I I11e5 I~r

4Mr'rrc ne Ir . +{>~Y u coK

., .n i./ per F a ., .r AM ' .- .,,g l.r MIS mm nU •t...JlraW

r

lrw ~~wMMai . c ~ r ., .,,re rc Iu c ihr ~.r~un, . 1 x)-SS X00 w+ 347 I yuo7a, wlye C-M NM+ +M~"r'DMr+11MY~.,-p r. .i ..uo C .fl3 ~AiI, IV .,IM ww]rNY .hlntl :.~NL~1e 1 .. . Ilralw ,rydmal ;. r .w '.rn nr it. .Y $2C J110'Ot ,+1Cr Uy In* NWrr1"yt,y

i IJ] A01 3 N.WW1 •~Cwlrw 1-0? l 4d WAi W,h Mcoi .CI IV 1`4$ NA mien CLn.U4 0Cqr ..1CU rj

7 .^•rb Ld c m at 1.6 y. ~C, M.- P,UI•„ar.on drpfclCO OFF 'Flo* Wfel awllagoo,`r rM f,/.IPS Trot Ale L"O . lryt 'Wrr%&l a

r SIM. A • .1* 1ucn4 in "1e 1J 10 ..nJ ,f nd . ,+ r{r.w7rO . :C .X1la.Ws WMl .r~y 4y+ ~su ~u N.n a V1{ Ji rni ,nlpmrfa~r' in '1MY .fillm rr .61 ISCONrOfn .h AM Ine

a A h PU'-n ~V l .ucd nt On '1 ,e* r 4rY 4 16Fr , e rI UYla,c Jlgn Id _ZI)I,rr*fVk Wy nClvJN~ %,VCI -C C. 4Ountrtn ' r. y,nr [ e :.r! .ne ,nw0 rya .rr

: u n

Ie M-4,3 Ir4R Ink ild ~5k' ~rC~rv ... W,11r .{In eaY tar no Caw u.rlr c6re+ea J earln

In* Iacwiv r d *Jl,many S nq C r,Yak't :cunyu ~C4lin oew. :.,/ .n .nu N.'"pif Certlewom C,N I ar li 11 fun L'k IC m . no rare -1 rX.M Conaa rr

b.rl Irr : w Nny :u lna Ail(n ✓14 lo.my OV.;InC . itC-, i4 I r,) . Jr•r mire I11an

"IWO e a alaaW

eew a.~l.ler .oe' ~nr - 1 . tan,r "Yleo n sec1 .:,n ❑42 50 lan.~ ya , can I .. , nu w .u 3v1 ct, nibu lal cape CAB 415,324 1262 lu

of In# LACU UiW A ~n jecirw `M .11 III irk d*dr, Ara 3-47 Cx. Tr.r. , rah m3l.un

Ma 3arat' O.rYr1 1 ..4 It flayYll,r.~.r.rr ' . h Ocil .i n7ev .."~r01r., dtlYftoW A tw~ ..

.aa un,ler .x JLf1o Tank? o Al be YuOdrCI to.[k efA .

Tm.y;INY .1 In[ • .Ier di M" Gr tw'. r0 by a rCJIkIC1Y0 •~(tiIM &A .. r., .nJ...IwnS nr.r nrdally oagun PLt7+mi Cr OCAan

0 wYru -I I ar iIIao.+s «aStrr k44 ur, .a.twuY,,'O yrntl Mlr~ W"k✓ e Jw to w.,C&, .iyWar.,n `iarnr r

.r>. .,.r wan VC J QLa1 U 1iIy'arN 9 Th.,14 ld iwlr4r ;Ndmal.On_ . .. . .~.: r .. . . ,:r : - v

Q,bCK W U_ CAM t'ORP ION- ELSE aU1J&

2L O Fr* T PI*LIAL 1.4W`! ELSEC i)UOON

NOTI ALL

tie.. ,C.=mmi , . dw r Alm "

- -

tI Raelit y

1Zl!'JtiLTDJ N ~.

1018 710 G3O0

aawhne Sim oA% ] .4' uu Irrr

CA 9oz4 5

Z_ W .7 . CaSTAS

7 T : w

h1..Iq .ann.

itGi 3 C kK0GA- AVF_- CM.WCA PA Q

UNoIROnouNC COrfT4M(AS 1aual RIa$TIA "IN IF iTATI AND/OR LOCAL / I11h1TS AAI IN FO11Ct

IyA+r ...1 tr. ...l .r .!rar

7 ThKKScard 4eM-

.~1.• - Iur vnr r.rr . /" PnuA ., .n wn .

PR.t WI1 SEtt IMS P1RL OEM 8116-A14

COMPLETE THE FOLLOWING ON A UEPAAATIF FORM FOR EACH CONTAINZA

IV Diicrlpua r

A. ❑ 11 1 Tank ❑ ,o Sum p

B Marlulacturer (it ipofoprlale) :

0 Comatar C&P1CTI zo O/

❑ w Urwrlown

G DO" IheCOYMaV1af St ore ICMcK Or») - Waste (3 W P,oduct R4 /

y e .r a.

Qv M010I tieroch F Wl Slallon 't,t Otrlay

Omer

year of Ml q

C UnknO*n

F is Conta,n« currently uwa' Ita, Yea Car No It No, year ol last use

H Does the Carwarlef Siore MOIor Vemc4 F-.kr of Wl,ur 00 0,,• Yea rw, No it Yes . CrwCk apwogr lie odkr11) .

C r, Unleade d

V ConleI.w CoMtncM011

A Tntckness at Pn,rrtary Conlmvr.* lk f ❑ Gauge

. . . . .. ...........

Srnch.r L7 Cm ❑ Unknow n

B ❑ s V Weed ( LOGaletl n An un*efq(Ound Vadt)of

_ Non- yI ai5I ❑ s . unknow n

C O o. pouts. Wdlted J K Slny)1r WelluO ❑ . Lu1SO ❑ , W'CDPSO ❑ Unknown C] a NON

0 0.. Carom Sleet C& Stainless Si" 0 n F .pe.giars ❑ . Pdlyvrryr Ciool .]e A C.xnCre41 d M AlurtftnL,m

[]a 51 00 CeO 04 Brort :S 0NaConnPOSde Q,,, Non•mwawc ❑ ,Esnnen Wand

O n Unknown 0 -, OW4 1

E O a. R.OOer Line ❑ w Alkyd Clung C Epd„ y Lurnq C.• Prwnorc Llrrr .g C a Gure Larnq ❑ w CLAv Clang

unkrryd C . L nkno*el ❑ . other

F . C tr'J,yel- Ent yyr. _..,/,r el N, .W...,y Q C,ylrladl, PILAv1•4n C - onw,.wr .. .

to l

HDMSeOO106351

A Associaled Piping %p, Above Ground A,. Unaerground 0l„ Veulle O

B Un06r9tourr0 Piping Prl. Gra+ ly ❑ l , Pressure ❑ o, SucliOn ❑ o. Unknown

_--C . Plplnp Repairs ❑ ciNoon • Unknown ❑ ci Yes Year of most recent repa ir

S b

VII Leak Detec ti on

Visual ❑ o SlockInventory ❑ I Tile Drain U w Vapor Snill Wells 0 o Sensur Instrumen t

❑ w Ground Water Monitoring We ll s ❑ Pressure Tesl ❑ re Internal lnspeclion

VIII ChemicafCompoaltlon of MaterlN. Curren tly orPrevlously 9lored In Underground Conlelnarell0 s ,i limnl l .u uII uu Cno[hud yen 10 IV -H uu uru nu. rvgdlruo le d onlp

elwwwM . n, . N„. .1 rir .Lw~~,~ .. r..a&,,r ,. IV.r' . p .ll y.~ l0rIN~ l1x rl Nil . IM. '

❑ o l

❑ of i1~~1111111J1 - -00, ❑ 0_

❑ ol ❑ oy -A

❑or

❑ n l

❑ OG. . . . .

IIt III IIIIIIIIIIIIIIII I

I I I I I I 11 LIIIIIIIIIIII I

IS Conlainer loceled on an Agncullurel Farm' Do Ye s

IXIMPORTANTI Fleed instructions before siunin p

111149nalure• 1ne lurm musk be b1 9rleu Dy 1 I aeprincipal u .ecuhve cli cor at Ihe level of vl .c -preslaanl or Dy an aulnolued iepreferNallve The representelrve

must be respoln6 ble tor Ihe Overall operation 01 the IaClllly where Ine larlk ( 61 are located 2) a general pawner prollrielpr . at 31 a prlnClP8l HMICullve oltlce1

ranking eleclud official ix aulnw4eid repleaenla livs of a public a9ency .

This farm has Dean completed undCI the penally of perjury Lino 10 the best W my knowledge is tr ue and C orrec t

bgior .. n

P ..wd Nar..l'1kk

on .

Pmrr *, a1 I °

$.nd chaak leo; H8Tardous Sub IanCe Storage Statement Slate Water ReSourcar Control Board P U Box 100, Sacramento CA 95801 .0100

P

? -" rpuu _

1 OD- S 72 6

For addl tl onal forma or monInformatlon call 919 / 324.1262

FOR STATE USE ONLY. . ..,IN~I IyI NWI

84 1]+W1

HDMSe00106352

Otticial Registration For m

bHatardous Su stanu Drag e:ra 7$t a StatementCMttornla Wrhr Rotaowcen Control boar d

tMMYraM P1.. L .cnparson u(rrrpnaistaous substances r01nywlaro

gluuho C ont . rleI m131 tai: mss larrn M ta'er Ihan July 1 l9(14 (Allot OClooar111n 1 1,

L . Iti an0 nu lalel loan January 1 190514 lynks alto o

peerdaon M Uhootpro ld CoIIWnan Tne law appuek 1o corOCJCI WWimps Worn ulleo taf ea ldnAL o 0h,, wrlae,0lUJrla tunl.ulai ► r Walet .

Cut. l.ecnun 131731 All C3M4neri ?rrCIal rv,l canrle ri waxed per parest m ulh! o *W ap,uyr,a rlatOons and aunlpIt lMat ale WOW IN rQl r

Ia i,jel A l4r.k lul, nd an Ine y,buna it, rice nclioo,a Can'llnt^s [irl,a I!

btrW4lh Irh: YUrlaCe itill, inCIy lea I l*O cw IFI iO O p,IS poriaa irklti lagOan ►ale Cavi,-0 d Sarin hat, oeerrt Iemove❑ hen Ink Glo,aCC -ft IC Cu6pOOI

VVM IiCddy NUinlal pfaoing 1 PCI CC1l5.OWreO c3r11.(aCl,on MMYOWW OU!"10

fovM

. . .. . . . :aria lum,Q .nl1 11 In(-uller,al mwbl oa col da Dy4 Ie1(lsloirC f,a.der pro

Pasaa ul at a huarUOus waelt wit it aapull ve ylNnt,4leC peil,Xe Oue 10

Mal or ddcomposii on of would nano nun,yns or w,Idd( y0, : must IOVIIAII

DeaNeon o(/MnrOa0 SUbSLrnaa Ar r ,aLylance nell:d in Section 6U2

GO the Lab, Coue Ca in Secl,on /I 11t u. Ire! Fitrau0 un.7 Saw IV Cane Trws

Includes psoinf al66tl luel all nou611 al itv-hlb poll o.00s 11th c.cles

1ha tars Aiiua IUt Ir1L.,oed

For: FOP (tact) tors isp .perep s 110 Nib mull bt paw ar.cep Mat re11

amine ldaxo-d pity S Pr tar s

P ,MIa*: Fcr lyaule In list, Inc penally it, 6500- f5 .000 pm cay it you IiiNllamal nn you can beIirMd up IC $206(•0 lot earn Otylnea!QrmaGOn ls

rrN:ulICl end 1111 not titan COnp0lea

rlalaft ; 11 rain nave o1wrnallarl soICle Dy Vatle IMCFN lawY

prulsv ■ II0Cn Y Ili[ 01 he Inlpril.t.C, On In,y ldm that 15 COrlllatrlr.0, ano In.

Iusw,Cal,an POP conlp@nl.Wly IrICluninp fpttdiCJ CIIIYOl CO lelevar! Slalu'

roil ilia 041w Lit .

tYWepM Contaplen . Fdt Kano II On One Iarn andkave it Olam on ax ire

remAV~ny 101.6 AlliCn all lams IO91Ihel stCi(tly II yp,. Own mat Iron60Ilnns you CanIWO rUC4rYwl On OnCOmpulsl lajleCal916/324 1262 It*

tnin-ajiun

This is not a P,Ma111 ApplCahttl . All UnaePQrourlC Tanks w10 ne auLyeCi in

IOCaI rtyurauom Some Ia1,so,clom slave sueaay bCCun programs ChoCa

w40 yOul Io•.4l County pOQefnmery Id Ju1111e1 "n millk (M)

NOTE All UNDERGROUND CONTAINERS HU¢T IILWIITEN IIY[N W STATI ANDl011LOCAL PE11WTi AM I% FO11C[.

sw'A ICdprl,W, , ..w v .Y ~4,L . AIl.ncr

pDCKWft.L Dlll'OILPW Dt'J-ELSECSU#JDd mco: .

a... A(yw .ELSE&OVI DD CA 90245I RL In4W yNT3 b F Fr T L'2 ....

Il FadMty_

FKrr .r. r

?n EMJtNE. .S FC ft . . W' - CO STNS

C

.r. . . Darr s..w

!G /~/5 :mot ✓~rr~

it a3 CP► NOGA, 1V

❑ ar M 04 01 Vehicle Fuel Station fVUOtner

III 24 Hour Emergency contact

car . Nit sent ry,. I.. I .11

PROTECTIVE sewIULSFIRP DEPT $l1-3i4 t3S l

COMPLETE THE FOLLOWING ON A UPARATE FORM FOR EACH CONTAINE R

IV Desedptlon

Do Tan k

B Manufacturer III Appropriate )

0 Container C a pacity ga ll ons

F . is Container currently used?

0 Does lne Corllarrler Store (CneckOne)

Qwrnw .lllAR It rrvv »no. . .a f ua

C Year Insta ll ed .-

mknown I E Container Repairs ❑ oi Non e

❑ ua No It NO year of Iota use

it Unknown

)In

IUD

Unkno w

❑ w Unknown

I„ Wane 0IN, Produc t

H Does the Corualner Slora Moto( Vehicle Fuel of Waste Ott') [2 . . yes

D ON Waage Oil 0

If Yes . Check appropraIe Doa ( ea )

V ConWnar Con,truc on

lFoergiass to Is Polyvinyl Cnlonda Goncrele 0 a1 Alultllnum

❑ Do Sleet Clad O w &onre O a Composite

❑ ,o Unknown O ,1 Of"

C Epoxy Lining ❑ . Phenolic Listing ❑ m Glass Luang O w Clay Lining

A Tnlckness co Primary Contalnmern ❑ Gauge ❑ inches 0 crn ClUnknown

Non-vauteO

CANOGA hA R .K

❑ w unknown

C ❑ oi Double Waited ❑ m Single Waled -Lined ❑ w Wrapped ❑ ur. Unknown 11 w Non e

8 . ❑ u, VouliOd (Locates in an un0er ground Vault )

Urulne0 ❑ ,l unknown ❑ ,, . Dire r

F ❑ . Fo•yelritene Wlep ❑

❑ m Sump ) Lagoon Pa or Porid ❑ w Omer

YearCd Mtg

Vir•y1 W,apl%rfl ❑ .,C lrioo o P,(iteti ,ol ❑ . Llrµlcwr

HDMSe00106353

A Associated Piping go, A00ve Ground 0 o: Underground 0 u~ Vaulted

B Underground Piping X

C . Piping Repairs

Gravity 0 ,. Pressure ❑ o Suction ❑ w Unknown

❑ cc None ?~s Unknown O u , yes year of most recent repai r

❑ o, Visual . . . . D cvStock Inventory ❑ r,rTae Drain 0 w Vapor SnrllWells O w Sensor Instrument

[I . Ground Water Monitoring Wells ❑ Pressure Test ❑ o. Internal inspection Non e

VIII Ch .mlc.t Compos ition of Mrtirlall Currprdy or Prnrlai sIy Stor.d in Underground Conlallnrr4

11 you Mc kui e n 10 IV H Uu d (C nut .u .c rud lu c:0m UIC u i* w ciw n

O othu r

.#o .er M .~M.•~ry:

o.w Ik. .P Gl{ . (H ~n[rw~~.

,d rw Iuw ..ar . ..y, .W.r•,, ..u ~ni.• . ur' _ _ _ . .

l I I I I I I I I I I I na ~~crn❑ u .

D o

Doi illlllllllll l

m iiiillllllll l

D o ❑ OC 1_ :10a .

a ur

00 .

11 1 1 11 1 11 11 1 1

1 JIIIIIIIII I

D o ,

❑ u

I I I I IIIIII IILI

• 11 11 1 1 1 11111 1

Is COniamer localeci on an AgriculturalFarm? ❑ or Yea prl v. N o

IX IMPORTANTI Reed instructions baron signing_

. . .. .,.. .._ .o . .~~.~~a The raoreaer$alwe

Pn w,r5$ wtjP

Mnd a *ck to ltaz ro1O0s Sucsiarlce E.Iorage Sluterneni Stare Water R.sotices Control Board PC) Bu . 100. Secrarnerito CA 85801 010 0

FOR STATE USE ONLY

U 0 .

mr The Ip/m must [n rdpneo pfinc .paioliicefOf the 1howy where I

nana lYrlktat weaocaled 2j \ genarel pannei Wopualor ;er 31 0 pr .~lp\ l bxec lltive 14er4

mi.iutLlncyt >wc aI j~a p u

rarwilig elected 01110151 Of ■UthorlIeo represeflalive oo C0910 0IS true Ono C09100the rice of mylinowledpeI d

T mTms low elar. been completed under IM pena lt y of perjury rho .

U

64 t16W

HDMSe00106354

Official Reglstratiori Formr. 1N Iilurrals GW ruonpwr R. owc.cC.morn a

we Covered it asrirCnas GBen .empvril Iron Ine Slolti~. Iola to cori9UUcl 1u y ano Ci ► a sw

The lac .i l N(nnial pr .o .r.Qj S rid CGriGdtled CJnsII .CLUn Detow IyUUr. d

itvo MulYpe ConMlrrn' FIG I and 11 on one !arm $no lUvc rl Dian on as 1ne

ryRladnn I (x n ,i AIIACh as forms lolxdnlrr sec rreiy a yii own more Iria n

W%e Moo Fla : LaCh perion sla .nd ,AZSI JbUL SUbsisnc. in any urtlm It sank ltigilra we lTMA.ort

g1U./W c evwiI muar 1*r Into corm nut liter Iben July 1 1984 Alter OClootir : Fd. each lank rag-stereo a 110 Is mWl be paid excep elit islir

~ .. . . . . .. I 196A wnd no ale . tin January 1 1905 10, wnrs uaeo Un larms, ga"rv PAtioAS pay 1 1 pm saner

Do "S" of UflI.i roUNn/ Con*Mnna Tra- rr Appl.rfto CGna. IRl{t PwwW.& for 1aiWe to 05 h IS penano '115X) S5 D0k pm Gay 11 you talus

" " ' 0 6 nor-Iii d Lunen I .rwi i t Ulnei an3t10iound GUnla .re05 1Waist inlormabon you can be fined up in $ 2 00 0 0to' each day Ilw ulcrmalrrxl it

Cuoo roclor.. 13173 Ali tenla rwrs iricu ony Canner withrd Cols ponds. ncwrr•cl ono hat nor L*en CUrrecle o

pNnl.on W1Y>trrreow 1. 16e1er1aa tin, S~,U61dr. Ce Pitted r. Suntan 638Zso inns Yon can tae .hire nighAh on CUITpuler tags Cab e)6f 4 IZBL Ito

of ahe Lafx. r 6 0Ue i,. in Sicbor, 0 1 nv Rt04n A rid S.4 i9y Cone Iris, Irlformal.U n

eal L .C1C1 r ibc diiS; l nli o 7 vr b pincluded 1iaroi.rlt drerel fuel an inWUalI sThis I. not ■ /err1111 A+pgeeeen . All llnprr prourW Tanks wiYpe fu[geCl to

And Ium.pJ nt$ If lnc nwienai miol DC- uI red ti Y a Irsllsleietl hiJlar ii r W pewtoCh rrrpulabdn_ :$pmt IJr .rd .CllanY hard 5i55] DC n wmL CniecS

pined UI Si a hsza/oo.l waste web d fxlait t jWrWTale5 pr1Lrure Out o- n n p idllC "must rv Alin wwhyWr "al Cuunly powernfMnl Or lurlnCi WorhtYtiWt

w.n

--- pQrlewlO lnr $ , rlaCC die .nc h. t4O ur'ta hi unLr ¢•o Pis pond6 .and

IapuanS wghhcal.On 1 0f Conhorrllialy Inaludltl (IipSCSlC Citations or telerir if We1 u7eQr►tW Alan . Mh n~on Irre pl ouA7 is not inCludvU Cor11eM Mrf Wr1

.e•1Y yrtla3c a llaLh a nsl of ine mlotlydhM on t his loins Mavis conlroent.a, aria th elaoUa'71 ahd urt pS that air 04_40* IT* nui Kral pr9urW Sunalc Rrel nrusl olhy : it you newt Information prolecleC by trade Seciet laws

u .a d rheal aI otcomposa .un C" wined norm

Hazardous Substance Storage Statement +•~'

NOTE ALL UNDIF11O11OUND CONTAINERS MUST REGISTER f"N ri STATE AND/Oft LOCAL F[IIaMT5 AM IN FORCE ,

I Owner

I zz3o ftST LMPe21A4 14w ~i

II Fee"

rr .px . . .YRr 0 5 tUe 1. 111 ar.d'mt a W. . MU cOaa

~z3SI - :-COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

IV D OOCrlpt on

Cl B, Tank 0 cc Su Lagoon P it ortor ❑ w Other

rrM~ww .ArtrN . II. .tit w. It, rrwmw now' 10

B Menutaclurer ( if approprlale) . . .. :Yogi 01 Mfg C Year Inelalled Unknown

D Container Cspacitylra -. p aneaionC ❑ Unknown E Container Repairs Doi None °y Unknown ❑ w Yes Year

F is Container currently used? You. ❑ ru No It No year of last Lisle ❑

Cl Dosstne Container Solo (Check One) O'b, Waite ❑ t Product

Unknown

It Yea,Check appropn$le boatel l

Oar ur$Caded ❑ o, Regular ❑ w Prenlum M a Asset ❑ w Wool* Oil 0 ( List )

V Conlln.r Car►atnactOW

A Thtckneli of Primary Containment D Gauge 0 Irlchesl 0 cm JW Unknown

Wrarvwl 171 or Unknown Oa Norte

,ma..

r D D 0 Caroan Sleep D aSla .rllel.l SIe61 ❑ o, FlbefgliSS Q s Polyvinyl Cniorioa Dar Concrete D as ,uunwwm

Do Steel Clad Dw Btonje 0o . Compotale ❑ . o Non •rnetaalC , Eannen Wills

Do Othe r

E ❑ a, R ontri Lined ❑ tai Alkyd Llrrn% ❑ uy Epoxy Lining D w Phenolic Lining ❑ a GIiS$ Lining ❑ as Clay citin g

/U

wrw .Cprn+.O^ u00* r a V.aa rl '

QOCKWJ U-(&(O2A'nON- ELSEGUAIDO

1

Ln i. javw ♦xar~.

ELSEGt1UOD CA 9024 5

"

Gun. I Ile

data r arm... . sp ....rh

Mc- W .7. WST111111IWar ma. - . . .

MD 1F-TD.Mt N E. ~S G-

Tb~e ► 3 C A►NOGA RV~ CANDC LPAR..IL A I A04.tor wrr.l . sa w

BIB 7W G 'Q

jq p b..n.r.

❑ u' Motor Vehicle Fuel Station Art, OthM'hrr&~ 1 M Y W

III 24 HOur En*ig.ncy Contact Psnon

M-W yip iv.... .1 rqw IN-u Al 011Aria

^~ / TNKKS Omr

den . tylrra . rr rrnr wire C 5T S r wr. gra b

gIQ,aTE TWg 5U.VIMS MOL DEPT 616.04

Undrr a ❑ ar unknown 0 .,. O f

D Poiyelioerto WIbp ❑ - V .nyi W aPA"ljl ❑ . Cranjo ., P(ole-'o .,n ❑ w Ur .n Uwr Nate ❑ w Oirtti T

HDMSeOO106355

• VI Piping

A Assaclaled Piping Q Aoove Ground u< Underground ❑ w Vaulted

B Urtdergrourld PipingA

I Grevlfy C l- Ci o, Sucnan ❑ N Unknow n

C piping Repairs ❑ , None /. Unknown ❑ u, Yes. Year or most recent repair

Id s

VII Look Detection

❑ - Tile Drain --- 0 Vapur Snit) Wells ❑ u. Sensor Instrument

lww

. rrrylu 10MWIll.: w- lwr,v. I WC*-rime l)LI N1 / crurxn-1..1 N.,nr~rlMrlr ~

~

❑0

II I IIII I IIII I❑ o"

❑ w

I I 1 I I 1 1 1I__I .l 1fr 1Jo" I'll,

i ~ Ill ~nwniu

,_,fr ff~~''~~~I1w Worm IL.,IATCZ

I l llllllll l❑ ol ❑ o I II LIIII I I I I I

I I IIIIIIIIII ID

I I I II I IIIIII IDoi

❑ 0L_

I I I III IIIIII I

I IIII III IIII I

II II I III IIII I

16 Co nt ainer localea an AgiiCullural Farm? ❑ of Yea if. ,

IMPORTANT] Read instructions before signing

alyrlelwit; Tne form must be a nea by I )a principal 6x0cul ve ullrcef &Iine Ifvel of vice- pre 1derll Of by en eulholl7ed rr eMel1al,ve The representative

.must 1}6.reepOflslble or the overall opereliOnOf the facility whei6 (tie tank( if are lotet6O 2 ) ■ Q6ne ( al pannier poprletor, a 3) 7 pllnCL al executive Officer .

reniiwQ Wec190 WUCMI Of aulhalrad represenlalIve of a pubic agenc y

Th . lam his been completed under the penalty of perjury Arta . to the beat of my knowleIQQ . is true Srld correct

Der

1W

Mnd chuck lo: Hazaraous Subetanco3ror& ye Statement Slate Water Resources Coned Boars P O Boo 100 Secrarrlertta CA 95601 .0100

NJ I ,

For additional forms or mom Information call 91WI24•1262

❑ se Ground Water Mon it oring Wells ❑ 1 r Pressura Test

Other

VIII Chemical Compos ition of Muirriafl CurrrrthIy or Prrvloysly Stored In Underground Containersu ornr rlwckou vun lu tV-H JUL dru nnl rt,4wlua loCOmdduiI 11116 5uLlxm

FOR STATE USE ONLYcr ln..na. Ai 1 v.iiu.~y Nw~~w caw.rr ..mo.+

04

HDMSe00106356

01hclal Registration For mC Nto"nea Water Rewire" Control Dow d

Hazardous Substance Storage Statement R S Snaiua0uc s u balar ( rs in any un0Q1 Iha ank Mawas br mwJdwerson alo innE p 9VA* Elkral ft : at

Qnruna (. arllalnei mull 111u mix form nod ale, than July 1 1964 IAller OC10i PM : F of eaCn lala 1/¢ uefe0 a flu Ne m.dl ba 401.0 aaCa s Vial r.ta

1 )9ba &t10 no tale, Inyn January I l tO 5 for lyr%ls use0 00 larmu 1 . Qa WLnC Nalionl pa, S5 per lynx

onoriben 1 1 LAWefyouAd Cantelrlan . fit law applwti to COnciele

a.rmpo rl0n.au0OO C-1'00 [arid" CA blr401 U'loorploonO cunlwnulo { Wale l

I. . . . 0011 µ:cl.0( 1J173i . Ali CLn;airrw1 riclulryl earlnt' r waxed CAk pOr .d 1

l1Q0Pn6 ano lumps Inal Alt! L 40w Inr• norr• ai a--Ill!) lurtyl.c -0V-1 n15s1

bvn(I ■ Ih Ire o.slsCC . l11 Ir cll.ciea lrlf0 ur . unlir.ytl pt, ponds and . ISOODrlk

l c,i I .i Cona ruare eoreloo 11 aarlr, has toter, iemo•eo non Inc 0l0layt ( ai e

Irle laoa•ly Noinial ryaOlrly Is n4 0060101100 CJnllruCLiOn b1.*Ow ground

aWl

D.Mrlraon of Haaardo I bal awboa Any yunklence lieltd in Seck .ln 6361

of Ine LOU-.Case .o in Se'CI Or 2 OIb of ir, hoalrl aria SYlc•ly Coot Try.

Incy"k Qtlsol ne a.eool fuel all inouuiial sol+enlO pes11CIOCS n.NtkC.oCk

arto lurrugdola II Inc rlalerlaI rrl io: rte cal . by a it~hllered rauNr .910

poked of if a NallfOO i.0 wawa a1Ie is B¢i0s .'1- Ier .llltl {neskure d ..C 10

I1fal Or OVCOmp0911lOn 04 wouic nyrlr nunlany C. W iClilo y C. . riluu i09i01W

749sldi A larw Lalhn,y 4 Ina Wourlc is not ooludu0 Canlalners partiall y

NOTE ALL U OIDERQIIQUND CONTAINERS MUST IIEtN .TEREVEN W ■ TATE AND/ ORLOCAL PERMITSAFIE INJOACE

I Ownerwvrr, Cave . •v.aroruour: r.VrrK n

RDLY WCU. Lb&('0 2.Xn V N- E L SEGVUt710Cap GSM !A

Q,W AM-

0ID CA 902452L 3b 91W LMPLQIRL 1r W! ELSE4

II FacMlty + :•.,', ,

tt .Tf.J N E. '$ Grw A*

~I-

a5a.. Iuir.luri 1.4011 .50

fL.. W .7.

YawRl Atlt/ ..f Cry oar Zr

.

l (. 3 C14NO VF CJ NDGA RA QJC A 9 Ij04Plow . : we. C00.

l .µ a 10116 01

❑ Moor Vehicle Fuel Station pynlrAtwl'0r►.r o`a 711"A" a au r acid.

TkKKS11111 wr Areas

Omr

PV"Ou a : ForlailWe Io 1 ;Ir Ir1C Fr loaa yy i0 f50U %S .000 per 0a II you lalulyirdormalinn You can bu lIWO iap IG :>•,20000 for Bach 05o Ifur lraorayl .or (L

rr1C(y1CCl ono MIS nor tieafl c0rrecle0

CaeMMrlYrlly: II you "Wit rruurrrlal .On p.ortcled by Uade iecrel law s

pleaku atlaun a liist of In4 lnrarryl,1Il1 on irus lDrnj Inal is ccrJ oonIs. aria Ina

u01A.Cal10n lot GOnbdenllaaly /rrGutlinO {p.C .tc C48bbr4 00 relbraw 0Ipru

lay arya case 4 w

Mkaeaaa Contalnera ' rat I 51x111 MI one loam and Iearb r elan. on all Ina

irnuil0riy looms Allacn all lamp IDgel001 iBCufe(y It you own 10011 11lan50 tank% you can Nov I lIC 1 iyli(51 on Cumpulel laps Caa§t61324 1262 IW

ktiamabu n

This to npl • MMOI Appll4Mkm . All UrOerproun0 Tanks woo be sole( to

kWal lugalnbOn Soma lur 11J.CIIOns hirr wlea (l y Degun programs Crroek

wAn oc. Io0Llcounty Q0Ve•nma*11 IN l0101Wi iNOrrrlali0n

Fwr

tit 24 Hour Emergency Confect P.rson

ar. .a.m., r.v - Tni. . . .

1KE S!R.V1(4SFIRP DEPT BIL•114 1hy. . w Irv wm • iru . . a

Z35 -Inwr. a a -i can.

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

IV O..crlpttar►

A ❑ u Tank ❑ crSump CO LopoO

9 Manufacturer ( ii lipproprale) Year of Mlp

-10 nSL 5' Insx55 ..r,r

C. year In5,alkd . . :.'g V nknown . . .

11on0 ❑ UnknownD Container CEPeCIfy6~ipo pa Container Repairs Owf None Xw Unknown ❑ m Yes Year

F is Contronol c i'renlly used? Yes ❑ o No II No, year 01 last use gar Unknown

G Does m1 Container Store ICNOC k

li Does the Container Store Motor Vehicle Fuel or Wales Oil? ❑ ,1 Ye s

❑ o, Unleaded Q

V Can

Dlece O a wa st e Oo

her Constructio n

A Tracknass of Primary Conlalnrr*nl . ❑ Gauge Prlncnes ❑ cm ❑ Unknow n

6 D o' Vallll ed ILOC11e0 in an underground Vault:) .

❑ of Doutsa Walled

.D . Dor Carpon Sloes 00, Stalrurr:ti Steel O al F rberplaSe ❑ w Paywnyi Crlo7rrde . .. : 0-Cnnclele 0 a Alumnum

slex1 Ciao ❑ 00 Brume ❑ i CorripoSlIe ❑ to Non-mWAlkc D I Earthen Wau s

❑ rayelnltnc' .Wisp . . . . . .'D- Vlr,yl WiaLUiny1 ❑ - C .tn .ai . Fir ult,,~ 1,,)n

Pd or Pond ❑ w Diner

HDMSe00106357

VI Piping

A Associated P,p4n9 Xu,Above Ground ' . UndstQ100nd Duo Vaulted

Gravity ❑ Pressures poi Suchdn ❑ . Unknow nB Underground Piping

o, Visual a v SIOCii Inventory --- ❑ o, Tee Chain ❑ w vapor Srnll wens ❑ - Senior Insuumanl

❑ ~ Ground Water MonllonnQ Wells 0,,, P

0 Other:

essure tes t

VIII Chqlnlcal Composition of Iu1 .rr.rlris Currently or Previously Stored in Underground Conulnh ►aII uuctlchrioye 6 to I V -.H UU dw n00 rpVul,ud l0 l=onlp, 1, lisle uoCllon

WvW .IWW dM .l,l Mrro.nr

Xu l

Co,oc>' ._S f-irt~

❑ oa Qcyr T -+~

❑ o r

Do, ❑ 02 1 I 1

❑ o,

IIIIIII I I I

111~~~iii~il l❑ of

❑ utU , ,

❑ or

IIIIII1 III U

18 . Container localeo on an Agricultural Farm? ❑ ur Yes JFw N o

IX IMPORTANTI Read Inslrucnons before signing

) a pae tloon of the i .c hiy whet[ nor laflhtSl arern~tr be reypQru lb4elot Inc overall operatiraruung elected official or a ulhorl0ed t i p0 errentitive of a public age nc yTaus tom heh been completed und6l the pi of p.rlury bnd . to me Beal of my lknowleage is Irue eno cdrreCl

ftnatun The form must be urgned by 1) 8 pt,nupil eMecul WdtiCH Ell Ina I.vel Ul v,ce • prayrd enl or by in SuttIX4ed, epre .e nl . live The repreBenlelwel pedrlaprop1161o : of 31aprrnClpUt e ut aCUtwa officerrte rI c. f d 2

agw.0

hvWo r.4ra,

or.

Prism r, ru CV

Send Check to : Ha.irdouut Subalrnce Storage Statement . Slate water R.eource, Conrrct Board P U Bloc 100 . S .brsrneriC CA 85&01-0100

Pnu ..

.' rw .4WlrwPrw,~ Yrrp

s

. . . .

For rd611110 l loran or nwra Informa tion call 91S/ 324-1262

AML

FOR STATE USE ONLYK t :w'u,y Nw„Pw

Paw n.c ... 13 00

rm . cc .,,,. a tiara . , i Liaryr:M .xOr ltiWrla n,ar lwn

IL

HDMSe0010635 8

C Piping Repairs ❑ i .r Nonc ❑ ,v Unknown ❑ v, Yes, Year of most tecenltepalr

VII Leak Deflection

I11 1111II :IU

pumps n0n .aupe0 Cdr,ec Inrtiof a tithe un0erground Lonra nLY! (wiles Atlahti rtr you coon 1w ilnt0 up lc $20D00 for eacr. elm) low rdamitio l is

1MM M4r1 P11i Et :rh pawn Limon nlliroOul SUoilanteL In any Limas she tank wiauk are KwI a1 d

puuno cooatntr mull 1* this lam no list ewnJuly 1 1 964 . tAllel C)cloial F•F: Fat each ism ripperto i tlo Its FIi ba pad excap mit rtwo1 tW trntl no, Isle, Inan Janwry 1 1985 101 Whpf etc on lirm► i gal.lnnt stations pay 95 per Lord

V - t hen e1 L S.iyOt CanWIMN TneId* ippwl. lu concrete uli U i. F UrIlblure to hw the perlailyIL 1500•sS .Doo p os t day or you lietI r

Cuoe 6UCIi1r, 131731 Ail cLrgduwrs. roc )fl- canner aihyld pits pass irwo reel arq root. roto r boon CUgecldo :_ .51OO0 u,i pis Bnd Lumps Incl. die Geldv. Isle nu+ ~". 11 you npvb onown.allon PrOlecli0 Dy tram secret 1wM1r a

F69

ul

sie1 A Ir rN trlLrl~ on Inc gl6und If not nCluouo ConOa4N"L p .Q,0fl Pleas. auScn a ilil Jr 1ht Blio1R,aI.On oni1MS loam IhII is movicerd o pntl inkUOrIfyr1o LrtnOo r

tivlll muffr f n' ,

yhuro16 b .natal W oeC Orrnpan on DI wOOd nal ls nooleroOUL

OV mWIiUgr7lm r.Ilri sow K/cil GVtlnl, g4v11nrtIY1rII l01 ) urrhtl rrrwe,l4pnPohlad or it iOr w lrIHl (nn

Official Registration For m

Hazardous Substance Storage Statement Q ccCallornla Watler RawurcerControl Board

. pegw . OrounIr.e tYLY,Iy No-of pradlny ,nIX COn},tl eieo cJn71l uCllU

MaUpis C WMri - FYI I and II on one !town and I5alve It dank on 14 Inc

r (5brliU uCc are LOvL4vO J eirih haS hoer, femOretl Irur' IhE SI 016yt B1YJU .

to." ow ca hb it .n : d

(I. .0 I}Ib p b~Ine0 :,, ur ~tLr,Lellpn Id LUrllroenlNldy I1 J r1{1 1YPecAIL c" lions Olre/tvilS llilut?LhL&jn trot fun .C1 •1C beC l

to wo ~ enY ,t 'l J Iprti> AllYCf alllormt lopctihtl ICCUtLP' In yp,r 0wr TOIL thanbn bn Sd -I acl .DsI n MCoot o .1 aubalarreai Any S ttllE 1d1e In 6t.3~J . 126210r. 50 ir*.~you can We rrnotrro OrI on cornpuumI Licit C

d Isle CaOul Cdcx :4 in Serction 15'sl6 OI Inc hosun ina SaRay Gatlb Tr%b wyWmavu nnCluoes garukne 0,efbl fuel pit Indusll d1 bOlvelIlh obnllc,tleh nrrGGde3 is

IIW i lsifelll a, 11GiY011 . AII LInO6r0rOUnd Toms wig he fuGlecr toono IumlpanlS II Ins Ilalenil muel be caln.n by B It Niflclktl r,aukl OIL

wafl4 Wla I5 ekplilt os Verso ales: pit-spine oue to ADCgT rs.latian Some Unba,000nb have sueldy begun pgplrmd CtiScO

MOT[' ALL UNDERGROUND CONTAINERS MUST REGISTER 1VEN IF STATE AND/OR LOCAL PIt11MIT1 AIIE IN PD11CE

I Ownerwar ,Cua . ur IAW4br ra r ..cla A9rrr~ .

.DCY W IE-U GDICC'0eXn V N - EL SC{i U1u00I.- •Oa wI

ILI,CAI Z 3 0 C FrST LM VLQIA L 1r4W ELSEC L JI O

II F*cI ty _ _ _

rZ It -1tL9 N

i~e~ 3 CA.P OG A I yEPt .e rlrw LOO.

la L TIP ODI* 150 5 l .rw. n ..r, Fa1an

111 24 Mou Emergency Contact Perso n

37 7Ptrft sA_rye I1iP'a'

a" . list rW n.r• . was n ra. Yn ow Nqx. 5511* I .vu .li nv .. r . .■t P1vrk- .w .ru car

--- - P'a1ITE Tl4 5e 0.tl/ 1 f,CSFI R DefT A iL 314 4Z3S 1

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

IV o..crlptlon

A ❑ n, Tank Sump s Li OOnPlt rI

p.. .rw.r r.tra Ir t 1q .rk.11 Mhy^ o"

C . Year Inslelled j 5 7 1~ ❑ Unknowr

❑ ." Motor Vahtce FuelSuUOn 0-O1nyar' MM` 1Ae-- RLRl MliLMwr

❑ w of"

B Manufacturer ( d appropnali ) . Year of Ml g

D Con tainer Capacity gallons ❑ Unknown

F Is Continue ! eurrenlly used!

Container Repair* ❑ s, None tjo. Unkn d

owf, I .W fh* kAirnrw'

W .-J. SThS

CAP4DC A. PA tLILDo w.CA " LAD4

Yet Year

u ors ❑al No I' No Year of loft use

G Does the Container Store (Chick One) : Waste

w Unknown

Product

N Does the Conta iner Store Motor Vehicle Fuel or Waste Coll? 0 . . Ye s

0 to, Unleaded 0 w Regular ❑ w Prenlum ❑ w Diesel 0 a wast e Oil ❑ as Omit ( Litt )

V Contalnu Conatruc$on

A Thickness Of Primary Gonlalnlnknl ❑ Gauge if Inches ❑ cm 0 Unknow n

B . OD, Vaunid (Locele0ln an underground Vault.) K Non-vauued ❑ o Unknown

C ❑ot Double Walled ' SYngleWeeed 0 Land 0 a WI gipped ❑ rw Unknown ❑w Non e

D 0 oi~ Carbon Steer ❑ to Stanrnest, Steel ❑ .t Fiperplais ❑ Ir Pdyvlnyt Crworroe /a Concrela ❑ is Alumnum

E Q m RuDbel Li ned

as &on a ❑a Gompostle p ; Non- rnelainc 0 n Earthen Wet s

y Coiner

Ll wAlkyO LlnlrlQ ❑ w Epoxy Lining ❑ w Phenolic Luring 0 orGlil:u Lining 0 a Clay, Lining

tanned 0 . Unknown 0w Of he

F ❑ ., Povetruenr=Wlep ❑ „ Vinyl W u[bofl ❑ . Csirnoo .c Protetillun ❑ -.. UIs.iiJwr, - None ❑ w Otruei: . .

HDMSe00106359

❑ w Ground Water Monitoring Wells - 0 i r Pressure Test ❑ w Internal inspection

Other

VIII Chrmlcal Compositlon of MatsrlalP Cu►ranllyor Pravbullly $lor ►d In Underground Contolnir fil

d 1 oln[Hutc INS buclro n❑ .Ill uu chucxdu yo 1 to IV = H uuaip nut IuVmr o

VI Piping

Above Ground jg a Underground ❑ ui VaultedA Meocialed Plpiny A

B Unoefgrouno Piping )karGravuy j1 i! Pressure ❑ or Suction ❑ Unknow n

C. Piping Repairs U cr None

uuun

❑ u i Yes Year Of most recent repair -

VII Look Palacllon

❑ ur Visual UuiStock Inventory - ❑ •, Tae Drain pu. Vapor{Sndt Wa1In ❑ n Sensox rnstruman l

rtl

❑ u +

❑ o,

❑ o i

❑ ur II .~~IIIIIIIIII I

❑ o'

or-v Unknown

Ca~mc~r:I ~N l/rr .4u.....ni .d Purr . tLIur S-"J~lrlw Iv nnor!wui

~~~~~IIIIIII I

w I IIIIIII I I I I I

I II III I IIIII I

Doi ❑

❑ o ,

❑ o r

Oof ❑

iillllllllll l

I I I III I II I I I I

I llltl l llllll -

l& Container localedon errAgriculluralFarm ' U ., Ye s

IX IMPORTANTI Read Inclructlons before signin g

"nature: The lorni mutt be brgrioo PV 1 i a principal execulwe elK:er of trio lever vice- president or by an authoozed r aeiep'tivve~Theeedetnue

mull be r esponoiDle for the ovsrlH operation of Ire Isc Iny where tne tarwrrr ore wcatad 2t a general psttner ptopirictiof ,

rnleure of a Putt aycnCye

No

srurwing elected oft Crel or sulhon0sd rep r

This lorm has been completed under the penally of perjury and to the t*ai ut my xnow looge . is true andcoi

hnutl wme

°f'~ w,wW cult

For o"do t.I lorms or morn Informedon call 61S/324 .126 2

FOR STATE USE ONLY

d . tMoY~r~v

A, ~wr.•~y n..iuw+

d ur

rar+r,ti,.~oM .

HDMSe00106360

rOfficial Registration For m

C Mlorrw w .Wr Reso1uc.sConlrOl board

Hazardous Substance Storage Statement S S - r3 -k-fie NOW PM : Each prison Mewing 0ILarauus Su-alrncnrs in any vroOW that lank wauii Ale Irlc"Oe d

LN1a conswnel resit Jilt this lam no Iau' than Jidy 1 I Qea (AIIt, Oc1O0e, Fee: FO, aich la(W Ii(talrri0 a S10 IN mWr be Paid * .CO 11W relad

ILdaanan, lull , than January r 1985 w tanks uses On tarme, 96wwr* Melon pry {b pat tan.1

JYaonl ol Urr .wOrowle Con4Mnni: The ld* appks.s to CCr1Cltite Il lnlail ia: Fw Ia~lwe to lw Inv P Iy ,& %500- S5.000 PC' aay 11 you lily

lumps nor, un0d t .,Mro I.n.6 01 alit., unarl Qlound Lonta,1ws I 5I5, INpmar , nn you can he hh*J Up 1a $20 OLIO la 01Lh pap the radrrlalldll d

CUde stClion 131731 Ak Conlirxrrfi nclylfrly CarlhUrl waaea pis ponds 1I wl&tcl kid has ml Dien clYfecAOd

I

S ono & ,irlps that mIt' oeru* the rOrnlal Qlwrla LUrta, L 11Yrk nly6t 11 ou hrvt Ir111r,rnallM p/olacletl th, Irade !eclat lawsr iw Alarlk Sill .I on Ina Qloonals nu ncluoro C3nlaulers parh•ry t~,~

.l..nahr _y

MQI's rlkrrM. aII.Lnr Nil 01 IJIeIIl0l n,whi fl on mis IOrm) hal is corllgirNlpl alto 14n na'I 00n saQds Jlit COh in, surface dit n(-IW0r0 LIne( Cv unllf.ea pd6 po pi 1a can6ornuxly IrlfJUOlnO Spec" CIIlrOrls 01 lilevinl 4.1110

He Cov YO ,I eaftn nits oeen rerroyen Iron Int S101adL 6,nr IL, CUnT IrNLIlacy rho Ci6e Ww

tt1i IaCJJyNrrlnlal plao,ny d not C0rlG0vIf-o conuluchon nalow prUUrxiMuMpI ContMawt: FJI I And ll on One lam And kivi it o4ne on 211 the

Iva* ANYCh all iorm6 Iopvlhr : I 5itC .xr 4 II VDU Own mat IlanMv~ IYmalnn ywonM n w Manr.p subwnw Any subslanCe listed in$ ecl,un 6382 50 tanks you Can III" InIGrrr kl I ,Gn nn compuIel tape CAN p16r3241262 ICs

Coot Iri salu. ono S ,IL~nr r1 f 5 y<o ep trx t rwl Cone w in n Section t! Vuo mauun4riCkge6 QasOSrle 1,1rdlIUe1 all Inousr, rl holv"nlb pt='SLC .dt{ rlrfb1 1dvs Tariks .ri ee auagrc ( to

arlo IUmIQdn16 . 11 Irlt rnrltril mual or call'td by a Il:yllslerhd ra Ilan Ols,~

b nal • hrn111 Aap.ciaoh : All UrldW glOUenls GIOLk

ptrsr0 UI IT a h&irldu,l6 Wasik Wit 1s expUS vt (1rntrl.l,S hies sudc 10 10CS1 rllrwal0n SOlne IJIIsdcllons hive rllea0

y rJC

boariks

win y0W bWlCUUNy Qpverrumanu ICs IU 111*' VNOrrnillorlhear uI dmCOmpOa .hN) Of would nirm hlaa3ns d -09110 yU rnUhJ l.1gAllr

MOTL ALL UMD[ 11611OUMD CONTAINERS MUST nlGIIT[ II MN P $TATrtAMO/OII LOCAL PERMI TS AM IM PO11CP .

I Own KIy ..r IW,nwa..• Ino.O1w r ruGlc r,fIIC . I

PDC.K WEU. Cd 1c OQPTW N - EL SEGUNDdMR" Aawwx

2 L 1b EAST LN IM LI R L 14W S ELSE&OUOD CA 9 71 5

II F.ckwY1 . _y w., ..

ILLIGttf.Tb) N E. S 1 FC.

rw

❑ a. Motor vehicle Fuel $11110n arw Other

~f~a3 C14NOGA rsVE CANo6 PAR-L A

811 TID- DOM~ a1 arad .l. mw Fa t

3 TNKKStwist Ar. .r. .D1Mr

QF, parry Iles. war will am .nor. ., was [Wk a,qr,... win. Irv ramv .uv , .no n,nly . WIl .. coal

&TIVE SERViuS~) R OEPI lili3 4~

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

IV D.sctiptl.n

A 0 o, Tank D in Sump osLapoon Fill or(Qa-) ❑ w Other

Manutaclulel ( 0 appropriate) Year Of MOQ

r.raw w lo w

121Mr(reraw IS .M

yyk.r . .. no r.rea. .aµyn .1t

C . Year Inatahad : -------- w

D Container Cape, uy "#so tiailonc 0 Unknown E Container Flapaar 0 o , None Unknown 0 a3 Yes Year

Unknown

F is Complier currently used? 00I Yesor-

No II No year of last use fit Unknown

0 Does Ind Container Store (Check One) 'Ei.0 ' WIHe ❑ a Produc t

O a . Unle aded ❑ w Regular ❑ a] Premium D w DieSil Cu Wavle Oa ❑ is Other (List )

H Does the Container Store Moles Vehicle Fuel or Waste 047 ❑ u1 Yea $Kw No II Yes . Chack appropriate balls )

N

V Conl.ln.r Con*ucYOf

A ThiCknlat: ol Primary Conrahnmtnl 0 Cwupe P.Irlchwi ❑ cm Jnknown

e (30, Vauned ( LOCAIed In an underplound Vsun,) pLw Non-vaukeo G u, unknow n

C ❑ Iii Double Walled ¶°r Srnflle Waxed ❑ w Linea ❑ a Wrapped 0 a Unknown ❑ w None

p ❑ .' Carotin Shia 0a'SIa1Mes6 Steel 0o Fiberglass ❑w PolyVlnyl Chloride 10 a COnCrele as AlurtWJ+wn

Do, Steel Clad ❑ w Br onze D w CompO Jle 0 +a NOn - melaAIG 0 I Fannon Willis

Q, : Unknown 1t l Other

E ❑ u, Ruooer Undo 10 w AMyd Llano ❑ w Epoxy lining 0 . . Phanokc Lining ❑ an Glais Lnlrlp ❑ In Cisy LJrwi9

untied ❑ I. Unknown ❑ w otte r

C . I'3l- etraer Wrap [)------ :

V .ny VY a6rlr ,rl0 Qv C AInutll~ Pri1,rhun ❑ ' Uflkrluwn Nbnc' QwOlt-w l

t3 S 1

W . -ff. COST^S

HDMSe00106361

*I Piping _ 11A Assocaled Piping . r"' Agove Ground $. Underground ❑ w Vaulted

B Underground PIp.nQ pl Gravay ❑ "1 Pressure. . . . . . ❑ Suction ❑ Li7 Unknown

C P,p,ng pepada, ❑ w None /11 Unknown ❑ a, Yes, Year of most recent repai r

VII LW Detection

❑ w Visual ❑ w Stock Invenloty CI III TileDrdin ❑ o Vapor Sniff Wells .-- ❑ C. Sensor instrument

❑ ,a Cirountl Water Monitoring Wets ❑ Pressure Test 0 u. Internal inspection A None

❑ ij Qlher

VIII Chem" Composition of Materials Curren tly or Previou sly Stared In Underground Containersu e suciwnIt you Checked y0b, w IV rl uuvw nut ru ulruo to-ruin m tr

tva a1Wy M.M.0 GIMt• 1.u U ., hi~ :l l . .-C . r rr v~' d .MU.rw IUw: ..WeM~. lr,.yyr rw .n .v ° .twtr

-W

❑ a l

❑ 01 007

❑u1 Qaz

❑ 01 ❑ 0l

❑ ul ❑ 117

0 01 002

01,❑

Our 11 C2

C] o1 ❑ W

❑ 0, ❑ m

❑ 01 ❑ m

Q0. 0 m

❑ ut ❑ m

Is Container located on an Agricullural Perm? ❑ul Yes No

P. r

IX IMPORTANT] Read Instructions before signing :

Sign Cues: Trw term mural De slgnetl try 1I a prulclpal eaBOUIIVe olllCer al lhr tool d vice-president or try an aulhorr2eo representative Thu represenlahve

mull de reeponalOW for the overall operalaln dune acuity wnele the Iarklal are localod 21 . a genera! partner proprlelot. or 31 a principal ealCUhve olbOer

ranking etecled official . or aulhonzeo spun entatne of a public agency

This form has Olsen complelea under the penny 01 peyury antl to the beat of my knowledge . is true area correc t

Pu n ,a Nam. Ti.. Prrar W, Musa CCW

$,nd ehaek tut Hazardous Substance Storage S1alenwm Slaie Wahx Resources Conlin board P D BOX too Sacramento CA 95801 0100

O Fw 511.a1. .M .yMN

C8 ui __.oo - 70,6

For addftfonu ]urns or mom IrdannsUen call 9161324-12111 2

FOR STATE USE ONL Y,D Nlnur

IC:Q al

84 31WD7

A . r :WU .,ry NwO ..w 0w+y Nw. .se

HDMSe00106362

Cttrclal Rtglstratlon Form . ~ dCa1Omla WSW ReaourtI Can" Board

Hazardous Substance Storage Statemen t

a Mwl FM : Eacn p.lwn stca,r Aata'oou SuhllanC .V$ t, any yr.10 Vie Li nk warw& Ore IewOadn nark ri Vrrutl a $10 Iae mwl be PArC a .C*$ N1ar raH.l

P=It]OU rr4 All .r Frla: Fp ra[gFu c,nnlrner mu51 Ikc m . lam rK1 later TFIan July 198a . lanwi5

iip

1 1WA ar.e rw 1a ICI Inan January f 19eS 14Y Wr0i 9WO Or1 10-U, ~Sawrw Stallions Pity[xl Ipp l$50W pm oar It r Yif. 15W-t n rlk yW pCW 1 alUle l 0

fMllnrrllon M Underpro iiI CarWnsn Tine low 6001W . 10 COnUINn Fla : F V Ii..

unla,flprf IAaler WV01Tal f1n OyGan hr INCA .. 1G 520000 lpr uaCR cloy Ihi I DimalrOn I{1qr CSJn 0nO\romps lon, rullrtl GuImO Idna6 [v Wnu y ,

.n r wawa 0xs pcr los 1 •rl urwi rla . not Open cunrurpn b n1 G wC.Oe .Wench a .J17J1 All tOGladlsns +rlcluninyW wa

rl C 'e .4 rllusl I mal .on alec'" in tr ade Secret lawsnw vLagoons and ,.rtps trial are L.00 . In1- norm. QI J., su 4 11 l'4 hY.W

ICIQSIeI A 1Lnx V11,r,~ On lr* Wountl IS ncr Ir ltluci Contawwrs pbri idly aS.w, YffaLh a Ili[ 01 Ihr lhJiI.al.un On bins Iorr• i trial is C0(4 /alai ah01f1a

prra:alh In, iJri .C C die 00,,000 Lini0 Cr yrd .rrrC. Pt' pena8 and laguuns ryatdlGalDn for cvnllnanGaaly 1nCluMnQ Lr(C l CAiUOnR l IalCryra Gialu-

Y ferrl0 va91fLnianh 510' ➢ yf1 elra l, cOi4lfpU l[L one COST I& WIxe i 1are CO . CO J rarln haS .

lac,l U1 gra Piny .s rloi CU(IGOwfeO C:un SI ULLQI) Gr10w yrUUndYWYFIa CAnWntil Fill I arw tt On Une ICxm aria Kave n Dian. w aN Ine

Inc NUr,1 0re Inanto Val U

.. rlf1ll ni.1 J fOrnb AIWCh all 10(mh IOgdlht4 LeC,Ydy fl you own 'R1

Sacl an 6]!12 ort cumpuler laDe C411 9T6c32a 1262 I H, 50iarw. a you can two lrllu rr4nriD06nwen of H&UHOUaSupauw".Any i.UUSlan- Iislr ..

51rIe1 Code Th.t sa lOI IM LBOLI Cone JY In SrCIIon [5 .110 OI Ihi nWOI r fJOrRlallufl

ncm.,"6 QasDkrle 0e8-1 fuel an Ind011111 .DlQer.lb pr81,C10ey 1 1001OMTIIIaM nOI a FIrr11V1 App1YCa60a

Al! Urgay910un0 Tanks Wla(1C SUO1aC110

L . .I ,e0 Oy6 IWglsler6tl Ilse tl DrsIM AI rCQW.akonSone lyrll3ICIIOns nave axewyee9unpogiams Chock

aro I n15 11 Ihr reelerUl mue IuC to1xI r L6 rap rtyLOrler pr ( 1

i.rlh yx' 1111 1 Iyou,

Dl i i

ptina UI al a rialaroous waste We l1$ n .u, VS row j sill! OuI lOG81 CGunly QOverrul* IOrl ItiVm wpu

heal . OYC21'npOSII Lrn Of wOUO ndrln nun dn6 of w . al114 ialQr

nNOT& ; ALL UNDERGROUND COMTAINERS MUST REWWaTER Mai IF STATE AND/OR LOCAL MAWT$ AM tM PO11C IL

I Owne rr.vrr cuadara, .O-S o r„ ax Atli I

QOLKWF_41. Cdl(O(LA~ ►DN- EL'% GUWOO G., Sim ,.

■'" ELSECa~Unl7-2-L-10 CA 90215~ItST LMPt*QIIFL 1r~W 9

II PrcMh y

fZJXJXL'TD.9 N E. FL

L 13 CANUGA-RVF

~L®' TId G 00rk.ra.r . p .Ta1w. . . i wr laCarl RUrU Ara m

TM(KS D' T

ar

Mt- W,3 . COST"

CANO (1L•'A Q_

III 27 Hour Em .rgency Contact Perron

Wa„ ,1.'a•• . .,. 0 14 Z S I

rip .. wr.~ "Win r..^I. 5V rrlla Will r4 PNfl• .r 544 Laryq .

IY SER~/I (CSF~Re, tied t3ti• A

Tank ❑ m Sump Joy Lagoon Pit or Pond ❑D . Other

IV D"COOon r rrraarI. ro

A ❑

A

coMPLETk THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

B Manufacturer ( rT appropriate)

ws,. ro nwrwl n.e .vu•1 .~, . .r.pa

Year of MIQ C Year Installed -

I

1A04

D Container Crprclly -1 osilon6 ❑ Unknown E Container Repairs Do None Unkrl b

F IS Container currently uieo'~ o . Yet. ❑ No If No year Of IW USE

U Does the Container Store (Chick One

Unknown

Willa ❑ ¢. Product

M Does Irw Conterner S1ora Motor Vehfcla Foul or WasIC Oil? ❑ wI ran AG No IL Vas Chock approprlale bon(es )

V C;wnWner

Roguler ❑ a Premium Q - Diesel Q in Wrsle OJ ❑ w Olher(Lru) .

A Th.ckneii of Primary Conlalnmlen1 ❑ Gauge )?'mesa: 0 cm ❑ Unknown

B ❑ a,Vaunad ( Located in in UrldeIprounO Vaurca C Non-varAed ❑ C- Unknow n

C ❑ o- Double Walled °' 5rn91e Wa&y d

D Di. CaiDon 51881 Da Stalnleo Steel

❑ w LiOCO ❑ w WtSpped D it, Unknow n

D Finerptalts pl.. Polyvin yl Chforlde

C P, Seel Clad ❑ a iorve D a. Compoute ❑ in Nan . rnetaWC 0 11 Eanne

0 y Unknown ❑ Is Olhei

E ❑ of Rubber Lined Dar AIryO Lining CJ o1 Epwy Lining ❑ a Phenolic Linin g

al"UNirkecl ❑ i urrmown ❑

Wrap cl_ vinyl Wlpuwn C ~ CLlnoo . Prol.OI ,un

Q a None

Condlele >-- 0aAlurrWlUm

0 Unknown

n ❑ am Yes

IVI Piping

A Associated PipingX

Above Ground Xw Underground ❑ o, Vaulte d

8 Underground Piping o, Gravity El "V Pressure [I at Suction ❑ w Unknow n

Cl Piping Repairs ❑ ,I None El 0 Unknown ❑ ul Yes Year of most recent repai r

❑ ri Visual ❑ k Stock lnvanlory ❑ lu Tile Drain ❑ w Vapur S niff Wells ❑ h Senses Inslrurnenl

❑ Ground Waler Mondoring Wells ❑ 1 Pressure Taal Q w irdtrnel Inbpection 01`u. Non e

❑ Other -,. .-

VIII Chemical Composition of Material* Curren tly or Previously Stored to Underground Containersr r . id-H .I so cnackuU ax too

s vn i1

C . .l lA . 5. 0 liar Lwiu i 'i'r .l H~nx luw ..~M•+Wi lrylx lu nrr'x lu'ii ~

.,W

dl

•npwYxy.u CH 11 1

❑ n.'J~

rY~~L

lrfl~' /~

- ~f'Q tM _ O F7 E!1/9 / ~ 7a% .❑ s ❑ ~

❑ oo ❑ U

Doi O w

❑ oI El m

001 Q u i

❑ ~I 00.

❑ dt ❑ w

❑ dl Oor

gnl ❑ m

ool_ __ ❑ d~

ou ~

Is Container located on an Agricultural Farm? 0,,, Yes ar No

IX IUPORTANTI Read lnstlucllons before signing

MUr.ill l ne form must be signed by 11 aprincipal esacuiive alicera! the level of vice -president or by an Iumor¢ed repreeenllhve The repreaeniatlve

must be tesponelute(or the overlk operation or Ina leclllty whore no lonk(s ) are located . 2T a general pannar proprietor . of 3)A principal exsCOllve d1CCr

ranking hatted 0111001 oraurtOrized repleaenlllrve of a pudic agency '

Thlt tam has seen completed unOei the penalty of perjury : and 10 the Will of my krli lepge Is Jlue Ir10 cUn ac t

wrwd N. .nuT" Pnaw .iCt. .

sand chat to: HexeroousSuOatance Siorege Statement Stare Wait,Aetiomceti Control Board P .0 Box 100 . Sacrarrignio . CA 9 -141W -01 W

For addftlonal lonrN or mars Informa tion call 916/324.1262

FOR STATE USE ONLY•ctU.na~~y rWiiloxl

O6' I0,k 0"

64 316' 7

used to coat(Iliac llsh 611LIlunrIV U

+r .

HDMSe00106364

rva . . ter . ri .-. .. . . .v~l nn Cnrm -- r. •.

Hazardous Substance Storage StatementCaMlornla Wet. Resources Contra Board

1 cti

x suourncas In .ny urkiw the Lank wawel are lrwi,,oepl od uales Wee PM . Lace pe .sun flici rq nuaQruu o Cdraa.Mr mug Rae in4 roan ow later Ivan Jdy 1 1909 ,Ailur 0000,110 Poo ; Fur eacr lam r SI ti-C ■ sisal lee mull n! Pa e .c4I not low

t9ri9 and M. Wier lean Janua9y 1 1905 for u .nMs ueao on larmrl gaai+I.i-iSlauons Pair 7S W ism

's"' e M lprl S I' CenlMnen : The I .J . appens -0 0p'w.Iela P.n.*rs: F Ix wit tO me the penally s SSoO-$51100 offer dap a yuu tansy

Sumps non . 0140 Cdr ed tans of utnel uriCtIgl0und cuNainotS Iwalw nformabon yaw can r tined AP 1 0 $20 o00 ton aiCn day IM Itawmp .un is

b e wi iletln ., cCuau. auwn ; J 1 73i All cOnlat•all ,- k :Yny. I rlrwn,..Wed : patr. t, . Incun~cl aM ha9d Ult

r l I wxe o1agOOnx And Sunps that .re ONO * the nor'taI 'y Wild Surta'c led "u9 Cenhdonerllr . it you nave intwmaunn Ixaecled Dy pope aac

rerglSlit A lam sailing an IneVrOUntl 4 not nCluoCd Got11aa1t++s partially µaaau ail l a list of the Iola rtialNn on ^1 form that IfCpnla]ZnlYil and Ins

.`s r prrrlCalh If~ lur ant, fa muluued ~~ l Un cr x C 0041 "Cl

sJ1114,1-11106 tot COM .ocrllaely rtG.rdmq Spec if ic Cial .On4 Q1 Iel•varn SlalU

Nrd I earn nal natln rE mO

v

6o IrUR I nY 0I O SIO1aQi ale b Iv C0111{Irunl• and Catty ta we covc yatn* ItClkly NWnlal J-ding IS ndl CunBAiiad :0nSl(UCIU(I Odlow I}round

MuMpieConlelnera_ Fa, I and If tin one lam and leave n i on all Ire

lava r~ma,rOnj IUmi Allach all lOriny ivy6nirr LYC,rfdly it you own moot than

Oee.rlllon q Ilaa•rdas+ euealsnce •ny subganca a1etl in radl, 4702 r iareiii you can law nlonn.rl on an campular tape Caa 918 ,724 12152 1(.w

C-1- r'ner Ten

u tckrdes 9aadMM . art tt lull ii nvualrial -ao DylS ehpglw Cx 11r:In.cdesThis I. n01 a hrmN API •tbn - All UndaegroundTanks trot pe iuplecl to

l Mg a yeyrslptatl rra un pogroms Cnp[a•atl py txaus aha l nM y pvrel r a ay ee e t NI[rI nil walL9n $Dlne Iy ~ya .cl onlind lumrgd rx if IW1 . VB yl@tIH aINS ptCYY.ae avu•

o pr}Wd Jrat J nolrrpOus waeW site 1

0 atpto

Ialu to wllh your local Luurlly pCvalnlnell Rot t tlntill N Ainalrollm g rul l eu ur u r 9• real 01 dacompODUOnof would harmnunlans or wao

NOTE ALL UNDIAOAOUND CONTAINERS MUST 11[01sT111 (VCN IF STATE AMD/OA LOCAL PEAMITI AM IN TOACL

I Ownerrrrrw ..ca.adarn w .acr dNrr,k .yr•cv

t7!)CK 1N U. C Dllt'ORA "t U N - ELSE-LSEUAOOCn

'2.L 3b GAST LMPLQIAL "W` ELSEhL JtO

paw. I uv.rrC, .441.4

a. ar

CA 9024 5

Mt_ vv 7. ST ... s 3 ~=Lr9 N EI fLf- O

C ry

ilea 3 C PPROGA A VR~ CAN XIArt'AUfa, A

N.Nr.or rr T#t 4Ir.ay

_818 710G-100

L 37 r1KKS_

Pt 1304

111 24 Hour Emergency Contact Perso n

OTECT vs sett 1IC sa I- DEPT aIa•3 ,9aCOMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINE R

IV DeecripltGn

A . ❑ a . Tank ❑ m Sump 0, Lagoon PI( o

. . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .. .

B Manuracturar (a appropriate)

lpr .lt► wnwa

Co Molar Vehicle Foal Station, a O(ner

Other,

: Year of hog

0 .0 alas (raw Ix ire u'4 X l w.ww .ar~y ynu i

PC . Year Inslallld 4-)'154 ❑ Unknown

0 container Capacil a--'gaYOnf ❑ Unknown' E Container Reprlr< ❑ o None Unknown 0

F is Cont ai ner currently used? Al Vet ❑ ua No It No . year of last use.

13 Does the Conralrwr Sloe (Check one) Wrslo ❑ u Produc t

11 Does the CoMalner Slone tv101or Vehicle fuel or With, 0117 ❑

Awe All"

o-r

Regular ❑ o3 Premium ❑

V Container ConstnlcYo n

A Thickness of Primary Co11ralnment: 0 Gauge lnycnes ❑ cm a Unknown

8 . ❑ a- Vauaea ( LOCaled in an unaerground Va ult .)

C ❑ o1 Double Walled Je u Bungle Waitlad ❑ w Uned

D. ❑ m Carotin Sleet' . .. . ❑ o. S tale rtfaa Slae1 ❑ os Fd>4ttglat9 ❑ c. Polyutnyl Cnlonde Concrete ❑ t• Aluminu m

C Bronze ❑ at Composite ❑ ,a Non-rtwtawC ❑ Eartnen Walla

Ol w r

E ❑ a . RUDOer Lined ❑ a Alkyd Lining ❑ at Epoxy Lrring ❑ PhonOUC Lining ❑ t Glass L1r4np ❑ a CiaY Linin g

f Unlined C A unknown Ll w 01 h

❑ . 1'oryelNe rlu Wrltp ❑ _ Vinyl WIjDWng per, Celnuolc Prulecnun ❑ w Urlnnown Now ❑ w oinkI l

'.v- Par.. l uk . ..mv '. ui utl r•*1 .' . .I . coo.

x 3fI

HDMSe00106365

VI Piping

A Asboc .ated Piping ❑ 0 Above Ground 0 . Undeirground Q- Vauitep

N Underground Piing )Z cr Gravely I] i~• Pressure ❑ o, Suction CTw Unknown

G Piping Repairs 0 i None 0 i - unknown Qt Yes Year of moci recent repair

VII Look Detectio n

❑ .1Visual Q02Stock lrivenlory---Oh .,TileDr,lin ❑ w VapurSNII Wells 0aoSen6ur Instrumen t

❑ w Ground Wale, Monnonng Wells Q Pressure Test ❑ . Internal Inspeclinr

❑ u OIner _ _ . __ ._

VIII Chemical Composition of MattrhW Currently or PravlouNy Stored In Underground Contal oo rs

it yuu Lnuckuu yu0 lu tV -H yuu ice nub r,u .Orrud is r.urr,pl, Ir Ir1 r!to n

0h 4c.& 1A, r., . .u.. ~, .,,,~.. . ~, .~ ru.,. ... lu . .. ww.. .•i. r.rw, .u• .'r JN ~ i

w.•ud wu.W Gq • rI

7-elt-

Do ❑

©o r

❑ ur _ _ : . Q o7 -A -1

L.

Pat a v&ND ro - i# jvA..4 -Sai

ll 1

❑ I I 1 1 ~ I_-1- - I❑ o .

❑ r,❑ ri IIIIIIIIIIII l

❑ ol Q11 I I I I 1 I I I I I I I _ `

16 Conlainer located on an Agricultural Farm? ❑ ciYes No

IX IMPORTANTI Read instructions before signin g

elonelun : Trw form moor be signed b 1, a prmapar a,ecuhve atl :cerai theieverof vice-preedem orDy AA e ulnor tad re xesanralive The reprseentallve

meal oe reeponaiOte lot lrie overall opeianori or lme faciity where I tl torwlhl a1R tocCted 2 ) ageneral pannar proplelor; Or 31 a picipolexeculrve olleet

ranking eluded wliciW rk autho(ana repiesenleive ol a pudic agenc y

True form ha6 beencompteled under the pehify of perjury and. to the Dcsr of my Nnowledyle ; is Itue and correct

how. .

Wwwa --14k,Ire r„o.w rn C~v

bend check 10: Hacemouri Substance SicuagSlaiementSlate Water Rmuries Cornrul Pound PQBo, 1u0 Sauamenlo : CA 95&01-0100

ForaddltlOnal forma or more information cab 016/I24.1 7

der r.,..,.ea Oi n JJd'

0f

HDMSe00106366

Official Reglslratlon For m

CelttornieWehr NesolweeU Control Boar d

Hazardous Substance Storage Statemen t

heal or OecOmpoiu,on Citwouro harm nunlane ur w,OII C you meal 1 .gsiw

NOTL• ALL UNDERGROUND COMTAINEReMUST IIRGISTl11 EVEN W STATE AND/OR LOCAL P1911 4T1rARE MiFORCE ,

I Owns

N- .oor ,

"2.2 3-0 911 r-NIMI .IAL I.FW 9

11 Fedllty

p., . larva ,LaU,.w.r . n .. i s I- , , nun .

PQJn ELTIVE. SWIMS #T QL DEPT' eIL•314

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

IV DescriptioneWiul ~r~l II f Irt f viesfh.,S ! W.~,,. .aa'I

A ❑ w Tank (] to Sump ofoLapoon P' or end : ❑ w Olney - NAN-

B Manul aclurer to appropriate) Year 01 M1p ❑ UnknownC Year Installe d

p Container CepaC'Iy - gillpnf C Unknown E COntatnel Asps re D uiNane Unknown ❑ m Vie Year.901

F . is Container currently used? ❑ u Ye 21t No It No , year of Iasi use (3 u, Unknown

(3 Does Ina Container Store (Check One) 4 Waste ❑ oProduCl

li Dose the Container Store Motor Vehicle Fuel or Waite Or(? D ., Yet X- No It Yei . Check approp ri ate boei.i)

C) o, Un eao ed . . . ❑ w Regular Q w Premium C o . Dleiel C] ro Waite Oa ❑ ca OIh.! ( Lwl). ,. ..~r,..~-. .

V Container ConstnlcWon

A Tnlckneis a Primary Conlainmtnl ❑ Goug e

❑ n' Veuue0 (Loceled in in unoerground Vaull .) : . .

rlpd r

❑ .v Motor Vanncie Fuel Stilton 02t, Q1lter

the lank Wales ala a1G..Ofd

F"; Fa each lava re?alerse a itu lee n,usl oe Pa11 . SAC* It'w . Irkp.wane uaepnl pay I . par La n k

FlatlalPIF: Fur ta. Iwe to kw the wlan y is s5olu- 55 .000 per eay a you rallAy

.nOrnUI,rrl yd,. can be lmrd Lau to 5700(IO tp each d11y IIw IItl0, rna1,0n re

In(.L,VICCi ape has nbl Dann crxreued . . .

Qwilipl,niaflly: II you hart orow"tldn pdeciso oy Ir .Oe w.crat Iawf

towasc diioc n a let dl Ir*irdoiItdt,On ontr0S Idrni trial is CONrdeM .Bi &n0. in*

lo$t,Io t .un Ipl [OntrderwraWy I tCtufSnQ Yp&clilc Cflahons Of ,elrvpm Walu

'tuy. and care. Ww

Mulcp5 Conl ln.r. f rC I and 11 on one Ic'r. and ,Care it Derv or, a ll Ins

rtrra,Il' norms Alt,cr Aa/ corns IOQPIIW. eaL Ire1Y II yO. . our Tot Irian

50 :ran- you can IrwdlIWnaiLW' Or, cornp,ler 1a ;:4 CAW !lillbt324 1262 lot

Irk.miGUn

Thpda not aIarertcAepIcaaen-AO Undlxplound Tanas will Isea rOlSCl tO

local iegu,auan Son.IpnSo.U10ns Aare a,rear, DCqul pr0Q1an1s Crtuck

wrin your ku:al cliultIr gc,rerrurlenl la /other AYOrrtut .On

Ill- COI*

Z3S 1

Inches 0 cm C3 Unknown

w Non- vaulted ❑ D., Unknown

G ❑ u, Do❑ blt Walled A S4F le Waieo ❑ ..n Lined 0 . Wrapped ❑ ,v Unknown ❑ a None

D. ❑ u Garcon Steel Q o.' StalrOr .e Steel ❑ of Flber()lbes ❑ w P0lyvinyi Chlorlce A Concrete O ji, Aluminum

Q 0, Steel Clad ❑ as Brouue O w Compoerte ❑ to Non -metawe 0 rt Earthen Wells

❑ u Unknown ❑ , 3 Oilier Guvmr mono

AltyO Llrhr>Q ❑ u Epley urging ❑ ar . Prwnokc Ltrsnp . . . . . Qor Glans 1" ❑ • Clay LiningE ❑ u, Ru )bal Wined ❑ w

X-Unlined ❑ ua Unknown ❑Ofne r

F C .1+CI1evo,,rw Wrap ❑ ~

wall, kuw PS', Each par von ylor,r naiardOvl sudalant':tf . in any urwA

Dourto Co 11,1SC-i must lAb Inn, Idm n(rarei Ulan ]Wy 1 1984 lAtin' OCIo .'

I 11kia Dino I-. t ter . l can January 11985101 lankly u0wd an urmkr

Diaawaon of ulmarrp.u .H Cotllalmra The lr* Appkeb Id COnCI al ttempt, rrorw• aned t oI t-a i,rla or DI•,e unoer0rifnd 4uraIirne'rs . iwa,n

C,+Or .ecnc;r, l11>31 At Ccrda,nlr-l$ ncl,,.Any canners watk'd Otis pdrran

LaQOPns and y„mpr Mal air rx,n .. the no,rr,ai ;1-1 7 surta .c wverr ".,W

rpglerw A tans iii,,, On the prdanC ,s nbl ,nctuaecl Containers (4r1 ..i4y

G` d c, Jrii .r.to pit, pdne6 ...n I& OCKU• : bemelr The kll .ct, ort •r.U.r0i0 Lrrk

ire co .14rrd Il aarln has [fe Cr removal IlUU Inv bIOla3L oleo IC, CcnUprc l

link LaC,uly NOtrU X .Ornt ,, not CLrrlNcieo CbnMruCliOn below pruurttl

wvel

DrMrlleon d waaroar aubatanc. . Ar .roylance I oleo inSect.an 682

al one Lkbu, Cooe . in Secoor 'r11y u iIn ho aim and Sally Coo, Tto Ir

mcka7el P.Ol;r* O,CSCl JUel ii' lnoustY5' swvrnlI, Pt5I1C .OL5 rNlb,t,(Je sArlo lumlpanls .11 the nlaer,al mull De C411„d by e t v(ILIeltd F, ulw OIS

puled 0) at a ha2aro0Iswaew site 16, ekp10e v( yerlelsI&S prr.•lyure Out td

R.OCK.W1EU- cO&(5ORA~DN- IrLSf"GVt1100`

CA 90245ELSE&OU6 D

rrwr w,r.

JtLTDJ NIZ,1C

-,Iw,m,.n ;s.pu. .. u

W .7. STP.S.W^,wa6 . NM,M w .., 1

7

C.,^~~

L.~ T S t1ic TJ %~ V a

6.0.%

i (o3 C 14NOGA I4VF_ CJ NOWI`f~AtL IL A 10 4MY_ y :1., LoO.

8125 710 (. 3OO-_ ~ t rrr n .. r r r y

Z:TRKKSRswat Areal t o . .rw IrCaOn

111 24 Hour Em.fgencyContact P.

V,ryl W1 aptdnp U . . Colh,33oo .. Prwee,.l,un C . url.nOwr - Nofk: 0

HDMSe00106367

V1 P1PIn p

A Associated Piping

6 UnderQrourrd Piping

Anovc Ground ❑ o Underground ❑ w Veulle d

3ravrly ❑ , Pressure . . . . ..'joj Suction ❑ , Unknown .. ..

C Piping Repairs Di None Orr Unknown Du, YoS Year of mdsl recent repai r

VII Lack Detection

•

❑ u l vlsunl ❑ u: Stock inventory ❑ 1 . Tile Drain 0 a Vapor5n Il Welts

0 v. Ground Wdldr M0niloring Wells Pressure Test ❑ w internal inspection

VIII Chemical Composition of Material Currently or Prlvlougly Stored to Underground Contalnar aII uu cnUCMtld U1 'L 1V F 1! alU"Ul IYV0rUd lO iom(ArIc 1111L$IlcriuIt

lyr~r4ry,~uvu

i .4 1rm . . IMawr

ClrwrlKM :li., Ni . Lwllilir^ .I N' .:ll.' iiw ya NY.I.M 'm. 1u Inyrv lurtl

Elul iTT NA

❑ ~~ __ _ par

❑ U ~ w

❑ oi o w

dot ❑

0

13 130 2

M 0, 0w-

❑ iii ❑ W

Is Conlalner localedon an Agricu lt ural Farm ? ❑ il Yes 0

IX IMPORTANT! Read Instructions Delore signin g

{tpnatur.: The form nicer be e&Qnea by 1 i a principal irnecUI1ve alto al the level 01 vice-plsaldenl or by an ailn0r12ed repreaonrallve The reprentraallve

mu61 be responsibleYOr Irw overall opera ti on of trle lacdey WI-Ore the lark( s) are lpcaled . 2) a pUntral partner propr oolprr Of 3) a prlncrp . I elfecrthae 0111M

ranking elected ollc 5l or autltaizedl epresenlalrve of a pubic ayeiicy

This tom ha6 been completed under the penally of peilury era to the best of my kneAAe0Je is lice and correc t

p, O Nyrl T►y Rgry ., .t.

Mend check to. I-Wardoue Suoalance Slurape Slydemere Stare Water Resources Control Baird P0 . Got 100 . Sacramento : CA95801- 0100

•- -Pwwn r .pIlwwnaa

( & 7c - 572.6

For addluonal forms or more information call V1/324-1M2

FOR STATE USE ONLYID N,--

0e

A,,a-y NaIIHr1

u, c .ra

HDMSe00106368

Otticlal Reaistratlon For mR Control ro.ralll w M w .C a om i . . uac +

Hazardous Substance Storage Statement

♦M. i 11 P1. Each p .lson alaln0 nala100u1 Su0slar.cllS In Yny u(COr uw Lank Wastes we rf1[IUOC O

glouno conla,nel muss l m6 10rmnU lwrl IhanJWy 1 I94 j Mer pclaour Fee: Fa ekCn !art r.pwele0 s 110 Me rnwl bt Paid ..cap mat rtu7I I9dA •nd nu 1alellnanJarnyry 1 f9851prIarJli ut :.l7-0r. Iarms , pasUkncMelons pay U pertaflk

Oi11ra ..n at Urr.BnSrotrn. Conlaln .rB Thr trig .ppk.s o cDnuma F'aa1BMlea For la,lwe Iu Will the prnh5yr n f500 f5 .000 per oay it you lalw yLurnPa nor .yune0 Co, N'O Hnal a olio url a QlWnd LJnI6,Iyx1 (*afar Ira0,r15al,nn yAy L Man be IId it. it, &200[10101 Bach day It* inlormuIUn Ia

73 r . nel a uanrk_riwaaedF,.ls pw,ua/l r/NI nl h

1.g1)u.l and sumps toil Jre Ufr(,w Ir5( er10f nla .Q uu 1u ~.c C.an11tl .1 .1Ba11y: 11 you hays INwmellOn prOISClVV by IIS I morel is*,.

C l e r rrI O

u, K S 1 {tM.[D y In[OlrcCI arq as nrN IMWnCUCult attl,Dn 1J1r rtl . . . rla I vW n1u l•

berWalh the S Vittaf L' J10 (• ,fCludeo t,noO Cu Jnl,/,e0 pi16 p(ulas 11`4 1JguOni k1a111,LJI,Dn its [Onl Ok nlraSIy nCIC1Ou &pacil1C C11aLCNq CO ralevani slal u

N Sly yp, own mwe llwrrAIISCh all 101015 lopcfnel bYC ~Im ..DsIaVllon olHatwreaw tudalanea: :' .any subElance uslt'0 n 5BCl .un 6392 . w can 1961500l :-' -,K

my,nlUnian0/'. On computer tier CaY 916i i2a 1262 lot

Bill, Iyp 'l aanr 'as badr remO-C Ir L,n tot 310, .,11 a,ea IL, Cv115I1,0 lay sn0 Cabe 6-I-

.heal a ducompos1i41n or wOUD narin hunwnaCa w,Ich,D you must l 59, 11Ur y w a V gDowd of al a hala'ODUS wasle SAL is 0 .pus, vc yer1C'IJles pr(rsswe OuC 10m o If I oorn ov.nrnera 1a luiiher ,raaRal (a1

Uw 6,DUndIs,pele0 Cons"luCl, O" DCI1W IICJ ,ly 10011111 giuan~1S n01 cc

plunk •tlaCf a Ilal at the ,man .l,un on in10 lam IrOl IS cnrllbera ,al Inc th e

Mu(PM ConWnart Fm l and 11 on on€ Ic+m al10leave I niank on aaln ev,,.al

oi lne LaburC(KUe :A in SeChon 25516 olrw neaan Br ig SQ1,10y Cme Trop Yril GOCS rKr Wi: dDS 'nlw nlau On

l nlOut vle s p1051 f C1 ae InpuSli a►ICItABi 3alOkna 0. eno tunll.anls If ipso fl,alellal MUM De C.aI, 00 by a rtlyllfn:l40 r i titr . Sts This be not a Pwra11 Application . AN UrWBrprOun0 Tanks wA be Lur/leCl t o

local IBgv,BUO41 S01htr 01UO .C1113% nevi wlOacly 00005 D,oQrami Cnc`CA

MOTR ALL UIaOR11Q11OUND CONTMN91111 MUST 11[Gl1TE11 EYtN IF STATE. aawfO 1 LOCAL PERMITS ARE IM FORCE

I Owi rI.a. d.".00 Aa.00,1-,000aaAn

M.., A00wl .

ZL 30 6#k&T LNPaILIAL %4W I

Are"TNKKS

III 24 How Emw9erncy Contact Perron

La" nun. .1WW ..r . w, row rnonr . ~rn a.o.

?IfLLJT&TI1IE SERVl Lf. FIRE DEPT /11>< 314Iyp. . N&- 14.. rwrt- Sill w15 - ra' . wo o cri*£35 1

COMPLETE THE FOLLOWING ON AEEPARATE FORM FOR EACH CONTAINER

TV ortt~crlptlon

yL.OV CM w, parllpl ► lil A larB ull ,ni o1 the ylroun0 ,b nll ,n C

iuucw .u. c~&eo2A~l0N -- EL SKiVUOorr .

ELSEGUU~D CATiv

9024 S

IZ~' +K.~T ) N E. S S FL - r- W -3. STASWig /.00gr

Iurw f1. . 55 0

V411,111, ellZip

itaa3 C 14t3O A 1VP~ c NOGAPARJ . 4 I D4roar . . : w. coo . 1rad aura. .

01 8 710 Co OOI

OILS❑ o Motor Vehicle Fuel Station p6a Omar't' fi(..... ..

mow

On Pit of Pond O w Othe r1 Lnk ❑T Sump eQOwA E3 o a

B M.nutaclurer (ii appropriate) Year of Mtp C Yew 7nslalea Unknown

z ,? MOO DD Container Capacll>~ patlloni 0 Unknown E Container Repairs ❑ It, None Vuy Unknown ❑ of Yes Year

F Is Container currentl y used' o, Yes ❑ a No If No . year ot last use 13 w unknown

0 Does Iris Conlalnsr Store (Check One) , Waste ❑ w PrOd0C1

[Syr NO 11 Yet ! Chock aptopdale box(*$)

H Does the Contains( Store Mot or Vehicle Fuel or Waste Oil? ❑ I„ Yet)

Os , Unleaded Cos Regular ❑ m Prarn um 0 w DIesa ❑ n wells Oi ❑ is Other (Lwt )

V Container ConatrucUoh

, -A Thickness of Primary COraalnme nl 0 Gauge ❑ Inches 0 cm ❑ Unknown

B . ❑ o, Vauned (LocalsO In an underQlound Vault) ❑ w Non•vauned ❑ w Unknown

Q w Wrapped f] k Unknown . NoneLlrte dlfQle walled 0tfi S0, waned ❑Doubl eC1C

❑ w Polyvinyl CMorpoe Oft Concrete ❑ aa AlunlnWnFibel plai so f❑lnleOL Stee l❑ wQ a 1 Caroon Steel 5laD .

❑ s' Steel Clad ❑a & on7e CC. Composure ❑ IaNon metaWC Earthen W.I S

❑ ,s Unknown ❑ .1 Other

E ❑ v, RWOnel uneij ❑ w Ae yo ur.nQ ❑ s Epoxy LxwIQ O - Phenolic Lirrrm ❑ n Glass Llrwtg C . a Coy LwnQ

o Unnnea C7 w Ursnvwn 0,.. Olne r

F' ❑ . 1'dyelrna .t W,i ❑ ,- Y,ryI Wlapp,n~ O CalrwoK Pt olecli rl ❑ Lltunilwn Nix Do Other

HDMSe00106369

VI Pipin g

A Associaled Plpir)Q Art Above, Ground ❑ .v Unoergraund ❑ oc Vouhed

B Underground Piping J(oiGravity ❑ 14 Pressure fa or Suction d c Unkno w n

C. Piping Repairs ❑ .r None XI. Unknown ❑ r,l Yery. Year of most recent repair

VII Lank Detectio n

X. Visual ❑ wStockinventory ❑ o . TrleDrain ❑ o Vapor SrAll Wols ❑ o~ Sensor Indium flI

❑ w Ground Wator Mon it oring Well s ❑ I Pressure test ❑ o Internal Inspection ❑ a None

VIII Chemi cal Composition of Malerlala Currently or Prevlotysly Stored In Underground Containe rsorWc: ke0 Aa IO IV-H `UU uru nor IuyJiloO to ulfl 1lc ui ., euuwn11uu

cwrr+.Yrr W-s.-M y CMwt.I iii .. I .Y .Ilar L.~III .vi'rrr / A..n .• ii- SwA . . i IW`^ rr. .nq. .r'WI

ur .w uuru

oI Dto

❑ o 1 1IL I! Li 111 1❑ o, IIIL~ IIIIIII I❑ o I

Dor

0 .1

❑ oI

D o I

❑ oI ❑ w I I L

O or

I I I J III I I

1 111 1 1111111 1❑ o l

Is Container tocaleo an an Agricu lt ura l Farm? Cv Ye s

IX IMPORTANTI Reaa instructi ons before signin g

B1BMlurs: The loan mull be signed by I I a prim a al 0000ulrve orliCer al Ihe levelof vice 1 laden) of by an surhorl[ eo ripleaerllatlve The repeaeolr6ve

moor 0s responsible or the overall operation or the facility wne ( e the lank, . are bcaled 2 ) a general parlIM proprietor , or 31 i principal executive olrrcal

ninlunQ eloctro olr,01al or authpged rep esenlalive of a public agenc y

This lam ha&oeen completed undir the penahy 0l perjury and 1 0 Itie teal of my know le dge . Is true arse Con

P,+Yd Noma T/v Pray w'rnp .'Q r.'

Band check to: Hazardous Subsrince Storage Sulement Slate wales Reaouices Corurol Board P 0 Box10D rSicnernenlb CA 95801 .0100

rn .W .r~ro uw

For eddll llonal forms or men informlion call 910/3 24- t

FOR STATE USE ONL YIdh..n.w

0.... {krt .r.rrro

A . . un .ay /+~i i

❑ yr K . r4

w•+r ar.m.r

r:ui

d 33A9

HDMSe00106370

Otilclal Registration FormI,,_. iwnla Weser Resowb . .

Hazardous Substance Storage Statement ~• 5 5~

■117Woo PIM: Eacn parson flotrrlQ nalar0Ors suoatanles in dny uniM-

qww cur11ad4r mull we th,Sarm IiL, Ioieq •Mn ,/uy 1 1084 (Allot OCIo11nr

1 19,04 Ong nu 18 10 inane Januiry I I 955 for LAIMS wifte on rirms l.,~ .~~~ .

. OAelar0 N

~1

(MdyeL C.elele.I1 : The Ia . Appkrl 10 C0u 1.1 11 5

I iwa pt Irwl WIOMfr-tic cunlyngra IWal .ydaump3 11-0,11-4100 r-00

aiCkAles, jatokr4 d.atel 1 .111 as lndusandl nuvclllS pail .C,des nrtlD . dalT111a ~ nQI a f'1fe111 A .Or1.. All UnderQfOUntl Tanks wrY Do fuGflYl la

puled ll

at l

1 II silo u, aWAS mpl M Cdlr dd by Yridsts id iia1Dmds UCal r,j,JIidnbn Sorne iui fliclion$ navd ai(L'aOy bllgi n proQram ► Check

hazneat Or

decamp

o

s

s iuin us or 0 . ,t aSulua •ve or - .Lee Y" LAI duo 10 wan vciw k4al L .unly javrnm(im la IwIrwr na miaton

wala au0

woul11

d0

amm~l,mJ.nb a wadlaM

isl1

.p,uer

NOTE: ALL LINDEI1011OUNO CONTUN[II$ MUST I IGI.T111 SHIN IF STAY. AND/O* LOCAL PE 11IT . AM INFO11C1 :

¢OCRW L C1WLP0RA1TIDN - EL St=GUNS -Ii io2L 3D ISAST LMPL.Q AL 14WI

11 FrcIMtyFew. w, ..

W .7. CO ST+RMDULF-TDit NE- S'S FL-hewer, a wl >,.

W.. ,.d.m

W-ng

i(33 C A .NOGA - NVLPI,.r~ * U.. wo a

10 71 016.0" 0 T- a ,. far-r, .

37 _T14F1 KS

111 24 Hour Emergency Contact Poisonrtnt' l.YI W Pntn, . r ..r .a emu./w{rxt ManM Ia .

QNa . N.rn. Ys na,r. w, .to Alor,t .'ern CS

gerE~rivra s lw~ccS FIRE. D€PT sla-a94 uan l

COMPLETE THE FOLLOWING ON A SEPARATE FORM PON EACH CONTAINER

IV D..cl uon

A. 0 Tank ❑ m Sump f Ir Lagoon Pll or Pond 0 w Other `

B Manufacturer ( it approprlera) . Year C4 Mtp

afooO Container Capacd gluons ❑ Unknow n

F. is Container Currently u&ed'y

ELSECiLUOUi.iiCA 01OZ4 5

D♦~.. luum+ n,sQk'rn

S

AAS10 SFL►C, Year Ifl8tal10q {.{ ~~~ ~ ❑ Unknown

_E Container Repairs ❑ o, None @fv Unknown 0 s Yes Year.

o, Yes ❑a No It No . year 01 last use : ❑ a Unknow n

0 Does the Container Store (Check One) Wa st e ❑ w Product

H Don ins ContainerSlore Molar Vehicle Fuel or Wave 0117 ❑ ,. . Yes aid No II Yea . Check appropriate Ooe(aa )

V Con

,~. d sire .

3ao a, Motor VrruCle Fuel Station r Omer

Runoff Ara"

Ode

Regular ❑ to Prenlum ❑ 0 06el 1Coi Waste Oil ❑ 1/ 01n.r (LlVI) .-

A Th,U( nesa ol Primary Contalnmarnl ❑ Gauge ❑ inches ❑ cm O Unknown

. ❑ ai VauiaQ (Localso n an underground Vault ) ❑ ie Non -Vaulted ❑ n Unknow n

D . Co . Carbon Steel Co. SIar7l.ss Si" ❑ ,, Fiberglass ❑ L. Polyvinyl Chlorli 0 Cob ConCreta ❑ a Aluminu m

❑ 01 Si sal Clad ❑ L. dionze ❑ w Composite ❑ ill Non• metalkc 1 is Earthen We ll s

ilea ❑ .a Unknown ❑ , Otne

❑ d. PrMno6C Lining 0 ru Gwat Lining ❑ all Gay Chang

0 ., Cdlnudn . PII)Ilt ll.in ❑ . Unnl,u#n /', NOnW ❑ w Omer .

LIlie c etIr 00 l L

. LB OveteO 11 ialln '

1 n5

$ aS 001n femoveb nUn Ina, lilOld ju arcs I(i COn ►tluLl IUy and Cew Ww

IM IICaay N1aiIN1 pt,ON 'S nor CciiCavretl cowtiuclmn new* V(uund4vtl1 MW1plin ConWn.ra: Pik I ant 11 on one Idm slid iea,a it oldltl an as Ine

rcmbnrny lOtme All4Cn aN I(umS IOpelnei 5,,C 1r ;Ny I rot. Own more Inds

In e

W I a I

n

kea ,Cl 0I1 IC Any r u 11 811 a hsled i01 c 7n b77)2 5,0 hat, ydu can 140 nro.rnai 4n an eumpulei laps Cal 916r324- 1262 l ow

of C

OO.

dB :lI '3ni.lion SJ 16 01 InU Flnan and JaLN y COO. Trot lnlotnai,on

11110 Ldbllr

P

h lN Intl (tied ~Ined l wrldbd R ponds drid49 - . .lusld,[JIK.n ILp co 1,6.14llYlyIr dI . d,nq spICIl C C+Ia G .YI1 Of felevanr •IJI U

C lWpy. rI you have mlcumalwn prolecled ti t' Irad . $aCral uwiIviOdna and h arpj that and 0[NOA IRe i 01 l ka]

e

a suria,u 9vo mus

C, IAa 112 p .W,i illy yraanu allrln a leer or it)q nIUlrTal ,on On [hit rim Illala► C0I1I 51114I Milt] In*rp¢fa l A lanllllnlth] on InF ylrouna fa nor Atli-O I

'

trw lana Waal.aMIM Flo.AdO _

F.a For hiCn tit* lepal .red $10 IN mwl Da paid .kcii trill retail

g . WMr.e alal-Ons pay $5 pe r tie-

PeeeMlia: Fvr larlr.te 10 h10 in* penany ;a fSCi. -$5 )0 pM nay a yoi laledyINOrinal- yci Gan ba lined „p IC $200001ot aaCh say IM ltOWmaI.on .►

CuOel aeal.on 1J1 .731 All a'nfa,fwi liClµyny Vannlrn waak' a pot WWI, irll iiII CI and has flCI beenCwtaClCo

s

E ❑ o . Rub M Uned ❑ w Alkyd Urwn ❑ w Epoxy Lolling

HDMSe00106371

AAssoclared Piping --- ❑ v,Above Ground o Underground D11r Vaulte d

❑ tie Ground Weld, Monitoring Well s

0 w Other.

0 1 Pressure Test ❑ , InternbllnspecUon AL. None

VIII Chemical Composition of Materials Currently or Previously Stored In Underground Container)

ii coo Grwckud yea t0 IV, H yuu old MI...i L,UUi,uo IC CUniiA I tI 1 111 .; OlI 1211 11 r 1

wnI b] Fni^ rM 111 .rlownlwry

Dui ;

D o r

0 1

D10

❑ rn

C1Mr1 SM I1. . A1+ r ' L,r•, u~h• 1: ✓ h~.i!y ,. . IU xi Mn 0 . p.IkL' u 11„1,1 s i,w,~ ,

0

... --

M1' eJ9AA G AM E2 A,lv~grt~e - F t e cn'a., p4s 4

w

I I J1

Suction El o Unknown

None D r . Unknown 0 L- i Yes Year of mo51 recent repair

1 II I

IIIIIIIIIIII I

II I II I I I I

-Dn ❑ xo I . l

Dot 'D d' J- I_I❑ 01 D

00, ❑

Do,

IIIII I I II II I I

I IIIIL111

is Container totaled on an Agricultural Farm? ❑ w Yes JWL No

IX IMPORTANTI Read inslrua0ons before signin g

p ,naval executiv e tithe deicer Si Irw level of vice p awdenl or uv an aulnonxed rep eae uakva The reprenenrakvaafpnalMn : Tn¢ Iwm muel be signed Dy 1 is tlue Wt11;er'muse be responsible or the Overall operation Dr lea lability where IncI Snorsi are locale0 2) a 900erai partner proprlalwc or 3) a principal

exeCllt

agencyrarlkin9 elected Ok dal or aulhwlz0nrepieaenlalive Of a pubk c

Thia form has boon completed under the penally of perjury antl to the best of my knowledge. is true ■ nd corlecl

Te. prier,. r. Nis

$.M chock 10 NazaraOus Subs ta nce Storage Statement Stale Water Reh-feet Control Board P 0 Box 100 . Saueme nio CA 95601 .0100

For additionarl forms or more Information call 616/324-1262

FOR STATE USE ONL YIO r../, 11,M n

, . wiJ iy N,.LI , RulerhWr,Pr' .

tvp~ Nw.r ..ra . ❑ u1

84 31Gw

B Underground Piping rw Uravlly ❑ Pressure 0

C Piping RErpalr s

. . . . . .. . . . . . . . .

❑ ,n Visual Dv.' Stock inventory . .. . . . ❑ u Tire Drain ❑ ir vapor Snill Wells ❑ 11, SenSOr Inst(umen l

VII Ls s k Disk" n

HDMSe00106372

n Formt t oOtt t ra llcla eglsrrdontu rol aorces CCalYtornla WsMr 11e.o

Hazardous Substance Storage Statement ' SS

Year 0$ Mlg

r4n s .,osrar l U ('fora ~n .5au.on d le2 . . .. ° y

►Iafare0ue SutieferKS: Y -.-- r__ SOunks yOU [anakr nlGi "an[n On CumpUad uyar CaO 918r324 . .1LBY lotDsa#Wdn WOf ITN! LAMA L,n v. In ~m .w .. . .. .. . . .~ --._ _ .- . _' _ Inlp mall on

uVCIuwa 3aW .M a.es.l loel all nlunO;al ,Urunly Dtil,l.de5 he O.G OVY . . . . T a~ a Parfait AppllGaYo0. All lJndOfpTOiJfw Tanks wW be euWetl lors Ir Ink I`~alsnab muil Ds Lambt Jr d ll t4W

Drs IOCiI r4Oyuwall0n Solve Iunsd.QINOlr5 nave xue9Jy 6a10Gn prOQralltf C'1CCkIe esall s t ue l0Ve erle[ OS

p nod t at ao mullpna2ar dous wdslY y.le If. et . wdK y our IOL&I Cuunty yorer nrnenlJot aralnei ,Npmepon

Of

J

yglnlelu kld hWuyoU mullrn nR .anh W D dw:

oneaOUr. fMa1 Jr oe teCJmpOeaWf9 or•

NQTC ALL UNOERQROUNO CONTAINERS MUST RIOI;T[ R EYSN If /TATI AIIIDJOR LOCAL I M 1TS ARE IN JO11CI.

QAt1CWI.U. L&('OQP►QIDN- EL SEGUNOOCly w rr

14ST LN95VAL 44W! EUSE iUL/ 0 CA 90245Fb 1' I _2 Z 1

II Foe"

ILL Jte 1-DJL N E`

rpuflOJln the nJ1 ace de inCluatrD steed ::" uN~nnA l-" ppnDl iM t)u IuhtmCAIron 10, On60dtnnakly lrlautling spe4IC CdakOnl,.. relevi a

MO bO In n, 1r Ltc .a,Je altld lu CGnalr uC rn re

Ie cXMS and fumph Inat are CCIOw Ine twrrvl gruur .n Su,IIce lest mustCsn .4elhINrye if you na .e Inlormaton p(Dlscled Dy Ire0B secret laws

r.-ty/lir A ; :rw plhn, an In! Qlourld .1 aor .ncluDaO CanIWle,$ plhrlly (Aealc all .cr a 117101 the +nlp rnau,n on IhisIorR Inil is conlldtnlfar ant InsOnl d ot V I

CuJe nerllcn 13173I Ak CDnlanell .-KIU .71r1q ant*(' waxed Gas DOf)l InLwk,c( dMl has "U1 {>een LI rucle aaumpr npnuaoIlSO tuleO Ianxf Or ,Irwl unodigloUnd . ur4Mrvrrs l nle InlprmaLUn you can hr ne Jp .

D .rr ?- sup-"MR ..W7. CD STA.S

Pf C.4,V oN

/tl . . __C zrJORTH

.L TE Tl SeU l(tS FIQL WK. 616-04I•wyna .*N .Iw4 rwixl . u4'~ Uw PIWrk r a.. .~Otle

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

IV Description

p o, Tank 0 m Sump . Lagoon Pit o Port O w Other

B Manutaciurer ( it ippr0prlale )

0 CoMalner Capacity glItorlf

F . IS Cdntantlr currently uaed7

G Does Ina Container Slot . (Cn ck One)

Unknown

mdu aM1 l .,,n 4114 - n ak IOrl11h IOQulrti4I hecUruty IIyou Own mote Ira n

a wafts .. no "O' i4w .WTI' Uwe- •• ~~~

C . Year Installed :

E Container Repairs ❑ a None UnknOwl

33/Unknown

❑ u No . . . It No . year of last use `. ❑ w unknown

G. waste ❑ I Product

HDoes the ContainerStore MOlor VeMcte Fuel or Wage W 0 v . Yes

❑ ai unleaded 13 w Regular C3 m Premium Co. pwset ❑ w Waste 00 ❑ as Other (List )

d. C3 ii- Vaullard (Located in an unaaegioundVault . j

C ❑ if, Double Walted fa} :.:Slrlgl. Waited ❑ + used ❑ a Wrapped ❑ a Unknown ❑ o. None

D ❑ cI Carotin Steel ❑ Stainless Steel ❑ lad Floerglass ❑ v. PCayvlnyl Cram Oe gfo. Corocrate ❑ w Aluminum

❑ af Slam Clad ❑ m &onre Ow CompOsale ❑ . o Non•malalkC C3 - . Earthen Willis

❑ u Unknown ❑ o Other

E ❑ u . RuoOer tined C3 w Alkyd LIrwtg ❑ w Epoxy urging 0 - PhenOI .c L,n.ng ❑ ,n C esti Lisa ❑ as Cady Llrlrri9

A Un lined ❑ w Urwnown ❑ o. Other

F ❑ . eol trot 1iene Wra p

, Wn %IC.nQ nualcuu3 ;JCUL1' h3 n any ifula ins Ienk 0-11k/ be NrC,4i-wof aC h1 /taYM Y p:t e w w reiaeed a Ce l rl .. p Jl W pQI &eI sO a s IU to m i

gruuna cOnla,nef must IS, lh.3 loan nU tats Ivan JWy 1 1984 tArlrl 0cluher Few. For each far* r e

~ . 1494 am nun idler That) alWfy I 1565 tot area vue Cal larmfl 0* .OMna slaaon5 pay a~ per lan k

DNIrra$so s6 UnAsrs /rrla Cantasniaai The law apow% lo conr, rete :. .. mss; F l 0,1 .rie to pre Irw uani lly 5 MW-55" par clay it yuu Iallay

w r $20 rear la .lace clap The rrllormaoon is

uAry

Nus," Gu. . w.w

4exLe

UY ®w. :IP --

CAhIM& PA Z ,14 - 1304unerr 4'ra cer. Nr a eu..w.

f~ l 8 Tl D G 300 ❑ .I Mot« Veh :Cte Fuel Station ft Othe r

iGa3 C"14NOGA PkV

III 24 NOW Enwr9.ncyContact P rwn

Ma n r.nu ww r *AM Aries I'' ••rw'

3-) TP tl KS

(). . : hY .A 14r.

_

I.M . r,or.tlla wIY .. Lust`

NeLolls ra earth ne3ed Wry tint Cis ., 4d w

Ine leCal nlal doh V"S not CW .adf,(ad ,n%AiuCLUn nebw 4tUl.ndY Np Jr safaMpls CanfelnKF Fm 1 anD II On One )C11 and rare I ban . W all This

❑ : ; Vmrl W' ppllQ .. . . . . ❑ Calnupn' PI :lctili .rn a- UnlIiuwn OF .NOr,c ❑ A CIrrrer

NOA-vaulled C] 5-1 Unknown

HDMSeOO106373

VI Piping

.v . Stock inventoryVisual ❑ 0W Vapur SN11 Wells ❑ uc Sensor Instrument

Ground W&ler Monrlonnp Wells 0 , Pressure Test ❑ .. Internal lns(iecton K . None

-- ..I]1" Olnbl-

VIII Chemical Composition of Materials Curranlly or Previously Stored In Underground Contalnan

•nrr.rMy

of

b :you c u v

.YI04N CMwr.~1 : LJ. . ti, t (u! "i•,• ' .U' ( I~w ,..U~M .~W 4rrur .,u n,Uiu iu.„,

~ .AO 4w ties . ii' .Ai!pTh

❑ n~~/G L G c~/T~J/✓I.IrL~iV~J~Q >~1

❑ t, , 0,z

[:1 Q , ❑ m

pc . ❑ m

❑ oi Q ,

is Container located on an Agricultural Farm'? ❑ 1 Yet, A- No

i 11 L

IX 1UPORTANTI Read instructions before signing

a{pnelur. Tne loan Muhl oe n.gneo by 11 a pnnc,pal ekecoi vb dlicer at the lever orv,ce-presitlenr or by anautnpeed reprewrnative The ep(l nlalrve

'.mist be ieeponsiLrte 101 the overarr operalion of [he lacilily where Ine tank(s) arelocaleo 2) aganeral pprlnei propr .elot . or 3) a pinGpelexecutive officer

ranking elected 0110511 or Aulnnizaa repirsenlalivs of e Public ugy rlc y

This form ha . been completed under the penally of perjury Sntl to Ins best of my knowledge Is true And CCYteC I

r,w.a N.-prw,r .r w. . V

Send Ch"k to: HaZardous Substance Storage Statement Stale Water Resources Contra board, P C Box 100 . Sacesmenlo . CA 9S60P-0100

V- - 4 .ry &WU!nO,4 _

F or flyddltlorlal forma or man Information Call 91111/324.1262

A Associated Piping ❑ c, A0ovt Ground J it,, Underground ❑ I,, Veulle d

8 Unoergrourxl Pping , Gravity ❑ , ., Pressure ❑ o, Suctiert ❑ w Unknown

0 0 Year of most recent repairYC Piping Repairs ❑ , None a Unknown - es

VII Leak Defection

FOR STATE USE ONLYID N,.._,

ur,r . w .:r .ww

.. c n.li i vLluirv'n iv i'urrilu .lu nl,s' .N:IlvnII n V Iu IV -II uno

❑ ii L. LL

G,wrl ew.wn

HDMSe00106374

Official Registration Form 1'^•AM

Hazardouts Substance Storage Statement . , T -,,~ R)-Ctomta Wlter Resources Control Boarda a

t1YaeMull rant Eacn Delson sta,nc nalaroru. 5oouancef in any 4naier . . . . tr io loci wail lAs ,nLlrca dayv/ia , Lwx&ner mull like mi[ ram no ldrer 'ran Joy I 1984 AYIer Uclouer ~: Foi each lank ( suI±I I] ■ %I U lot must W ni except lnel ( afar . . . . .

1 191 end nu tall, (non January 1 1905 for Wnii used on army! gawwrre orations lily l p IK ulr* : . .

sumps ndn. AuaeO W(,tl0 rr nxs U :.when v, .7ef gr :}./ntl LuNainuYS 4waler ,NDII1aMtn you Canbr ti ned uu Io $20O6o iar each day the W11amalKin . s

C.ro.r wend(. Iii 731 All omo, null ncl L,.lny caft h6r, walteo 0% prxU s Ir4CCiICd and has not been c fr .Ci@D

1-000,0 and swnps mat are 0broW Inc n0rra1 4 ,,,.r -0 suna.. o H .w ;,,.y Gen gdotA 1r

, II ou nave InIUMAllon Wolecled by bade 0101(1 law n

Brit allr-Wm II Lmrry illueConwrww Toe I4* (A era to cancrele 'eneasew P .. Ira.,reao lie the ow mly L S500- SS OW Per day 11 yo u lalsily :--

rNq,srw A ..or ldl,nq an The gro. .na ,S no, nCLpea Conlia, Pr0 (.Ain.lry . . .Y

'W }M 4 o ~rtl3Ln A 110 of the ,niormal .Nl an mil tan that h COflI (yl4l and the1 rrdn d . ,Bon6i O. p 9♦ioer10rn1 In ,c yulyccIt .. .. . p ed .,nell w 'n, s P . . . WII CJlron Ili onj aii ati l u%I .,a,nq SptiCll ,c cllaudns d le,evam slaw : . . . . .

nn Oddn re -nov 17 11Un, Ine cinra ' au-a IG CansIIy

are Lo . 00C , eA eY +A Idly and Iasu Wwthe utCd,ly Nolrllal graO,ng s not - ons.04r(0 c 0nuiruclAn Dd4Ow gruono

a4JeolaConralnNa: For I Ana 11 On 0nel0rm and ady( it uIa1M x, an th eto Val

I Owner

y yrr t1 ll n o I lf0 DiilMkon of Ha$ardetia kMtanaa: Any &ubSt3riL1 ],sled 1) Secl,on 6182 maulrny o"': ac a 0v

ul me Lwow Caw . In Secron itt1b 6' IhC rleallhand S41cly Cuoe Tri ne.SO ear o rues can f" .nlu,rnauGn on cumpi , Ier Rape Cast 91b 3:c 1262 . pr

r4amauunIriCIu.4gaicllne a .esdi dupl all Ino .+oO of ,ulverlla (IrS1,C .deS rW 01U0BS

1(10fumlganl% IL the a alena1 mull be Carr 00 by 44 rryl3Ieled , Avl.n 0,5 TN.4. not a hrnWAppMealloiR - All LJndergrdufW Tanks v.,tl Oeauolecl l0

pusaovl 3.1 a nuardals Waste llle is i,lpf . e gena1Alos prtrsy .oe J .e 10. : . local roj . ollon Solne Iun .a ;cl,ons hard 4,14104 begun programs Cluck

heal x oIn Omp0alnx1 of w0WO nalm numany Or wodlila you mull. r.g,]lur .In yuu, 10Li1 Loudly 99.ernlnenl la Bother nuarntil,(V1

NOTE: ALL UN09ROMOUND CON1MNIRa YUIT RIGI$TtR KYIN W ITATI AND/OR LOCAL PIRWTI ARE N FORCE

, .rr.,,caaorm Iro .n.r u r,wc wercvl

tLDLKW .U.. £ &(5OQPtT 0N - ELStrsUPJ&&W . U I

'2.Z 30 E$rST LNQ1 QJAL 4FW~l

Ni0 Fu.s r rr I .wy

TArl~IKS

f it ou JWn Tprd Rann c PtIt IormS t r sA '

coELSEC~UUQD CA

1I 4

r .r:y Mi,rW 0*A - f uwrun SaK,.na -. .

RlY t.LTDI N E. W . CO STILS

v4 Ca /~w~ PL

£ % 3 CA4 06A AVa".C.r w RIP

UNOC PA RJI . A Ia304FAI,M . rr ` m.

BIB 71 D a loo40. a rw,w

[3 Major ten cle Fuel Slauon '6i Omar 1'LG ,7 RDCICEY"MV

Mani Ireee T own .o rlY+p sae.a l

lli 24 How fn*'gency Contact Parson

'Qi1rEcT'III SERVIfICS FIRE DES BIa 314 Y 3 S 1DIV.N.- I- r .r We .N II,Orr. . . 110 , W ny Ir/, rrm0 'IV' uA front w . r .u cww

COMPUTE TC FOLLOWING ON ASEPARATE FORM FOR EACH CONTAINER

A ❑ o, Tank ❑ m Sump - Lagoon P9 or) ❑ w Otherp.rp rhrny.r MW„rr

rr

6 Manufacturer ( e aoproprlale (: . - year Of Mlg UnknownC. Year Installed. .- . ,

O Coniwnwr CApacIIy ~ iv gallons 0 Unknown E Conlatnor Repalra , None ❑ oY UnllnOwn ❑ W Yes Y6er

F is Container currently uses? AiYea 0 w Na II No yearol !ail use: ❑ of unknown

G Does lhaContatrlw Store Knack One) or . Waue ❑ a Produc t

H Goer- lrta Container Sawe MOldr Vedic! . Fuel or walla or' ❑ ., Yet ;Pew No If yes Check .lppropr ,are boa(aei

p or Uneaoed ❑ w Regular ❑ o Premium ❑ o. DWSal ❑ . Waste Or ❑ a Dial( (Llst l

V Contain.(

A Tn.Ckrlwta of Pnmaly Containment L"'-1F3 ❑ Gaugw )Cinches 0 cm nknow n

E ; ❑ o . yautted ( LOGIIRO In an untlerground Vault ( w Ndrl o&ulttd ❑ m Unknow n10

C On' Doubld Walled $o Single Walled ❑ . Lutwd ❑ w Wrapped ❑ E Unknown 0 a None

D ❑ o, Carbon Steel ❑ c. Stdirlltso Sleet L7 i Fiberglass ❑ w Polyvinyl Cnlorrde 006 Corycrala ❑ as Aluminum

❑ ar Steel Clad ❑ a 6ron, e 0 w Cornposle ❑ ,o Noel metalli c ❑ it Eannen Wali 4

❑ ,7 Unknown ❑ is Omer T. -- - ..

E ❑ m Rubber Lined ❑ w Alkyd Uniting El a Epoxy Craig ❑ .. Phenolic Li ni ng ❑ o~Glasa Llr Ag ❑ as Clay Linin g

if.Un1,n10 ❑ .u Urwnown C3 w Other

F 0 . !'Dryelnlerlc wrap vinyl Wra i..r1 ❑ Celnod.i Pnliei Lan ❑ Lin . Wwn /I- None OA OI Cr

HDMSe00106375

., C ..Vl Plpinp

A Assocraled Piping [IQ, Above Ground--- :Zp Underground --- O Vdulled

B Underground Piping !"1 Gravely ❑ ru Pressur6 ❑ o3 Suction ❑ ry Unknown

C Piping Repairs None ❑ r, . Unknown ❑ ri YuS. Year Of nmoo) rec iffi tIl repair

VII Look Detectio n

p o . ViSudl ❑ LL' Stock Invonlcry: . . . . . . Q

e Ground Water Mundonng Wells

Other.

..e..nxr..o-r,o .

Poi❑ ~r

y rru ryou r

r ... ..whwpb Z:µ • nrxrw. . r

❑ or

C~rrr. O.: r : iM(V ..(. d n..b _ Ww .&n. . :,i 1. M ru brun 1 ..,~r

p 0 ; ❑

0 0 1 0 o0ox

❑ 01 11 w

❑ oi oor

❑ o l7

❑ on ❑ m

00, 002

Is Container localed on an Agricullura) Fafm? 13 on Yes Ari. N o

IX IMPORTANTI Read inaRuc(lona before slynrn g

$Ianilurc Toe form mull be eroded by 1 i a principal xxUCUhve dllicer al trio level of wc6-presioanl or by an autrior aed repioserliebve The repre fienl8ere

muel be re$pxn6bia for the overall Oparanon of the facility where 1116 tank(a) ara lociled 2 ) a general pander propnelor , or 31 a principal executive picker ,

rranklnp elecrea official or ■ ulnorizei represenrehv6 01 a public iyerlCy

This form has peen completed under the penalty of perjury 8n0 10 the best or my krxiwteope is true and correct

Sqr o-

W.nx.o W-OPrim. . w ra CtW

JMnd check ro. Halerdous Substance Steaage Slalemenr Slate Water Rasourcea Control BasrO PO Box 100 . SaCremanto : CA 95&11-010(1

P- AOS 000r

Celd)

For addltlonal forma or more Information Gall 910/324-1262

FOR STATE USE ONL YID r+.~rvn. A, .onn-'8IwJiiO.n

C il• E0,

B4 316J1

HDMSe0010637 6

TTile U1dmn- ❑ w Vapor Sn if f Wells ❑ w Sensorlnstrumenl

VIII Chemical Compoaltlon of Materiels Currently or Previously Stared In Underground Containersill 1 V H uu-dill real rrRldrlOU 10 i Ornlo. IU ill aaOAunh :kud uII

1. 1 pBa ana nu filar loan J}nWrv 1 1905 13( ISMS uarra On larmhl paaoln& 11ai o n par $ pat lank

Caellornla wow IMaoures* Control boar dHazardous Substance Storage Statemen t

pprr " r.Orlla.rlA moil Ile In,,, IO(m ni. lair, than July 1 1984 IAller OCltwur pN ; Fd eacr 4nk rapWarao {1110 lea mall of praa am-epl ma. TrtleilrMe 111111,014 Fee. Lair pry dun gluing r i . doui lub{WrMti in any Ono" Wo Iini. Aail. a it . .r1Ca1J0o

, . .. . . . Oenirrrn Inenurl.[c .re ntI ... *a ,. rO Cr ya,r .pa pis p[nt7S 'lid IdgOOna _ . ..priiI .Lason Of Con! IIakly rn Judnq iptCdlc C4a tiOni OI i elevate alalu .

O,Ikl uLl• `

raplylm A Iyr1F pll.ri on Irre ~OUr0 t, nq inCluoea COrtI7Nre,1 Wr$ .aY F.ua1u .hyLn'•e5161 V be .nraerkurl on Irel lam that is CONtde•p41 &noIne

1w00m, ind sumps Inat dry C10Or. the nO'rw: gl-191 k,rrlkrr. la'I' n'16" 'Ot . a «,nrve nlornulgn praeCtea Dy va(Q aeern lew►CUOt aer,'rur I31 731 All .{vnl prlitf iXluNFkl 4anhCrlkxe0 pd6pW.Ok 1ri. riVcI and hat rdil UQen CUntCIe O

an be IVUrd up It 520000 la Oich Day INW 1110rm11.0nHWmpu non . .uneo CW WO L .r,. OI Pub ur.dalgrcynd Clime ; r ,ari (.Wiley /xdrmll nn you CD Ilaleen .1 Lklawgro UI CUINarraea Tnt law apprren to Cwxtnre : feF(awaa; F(KIa,INre to llle . The Ck'naxY it ~SOU•>4 1 .000 pet nay : u you lalad y

la is ckarc COuNICO it (,trio no i '.deep Iamoled Iron, the libb it aIcily irtI CI .r Ww

the Iac .ldy r..air4l plaoinq ; nacanamrreO conklruCt:On below gruntsMwap le Contellwra Fw 1 aua 11 on one lam and ltavn a doo* an all of

r ve tDaedIen a1 MaaaresiwWbalan", Any buUAiince Ililea r, SaCl .Un 6362

a fir,((. LOW CoOt is in Secbar, t5:tf6 of irk ndalln ono Sylelt COOT Tro y

incl..dee O7 k0h t ai014I reel all rnoufrlial klxvenly peal.c.Oei herb.C Cki 5

Official Registration For m

sno lumq dnli ii till, n .arelil mull Ot Ltrrdd d( a rej1laleliC hai,0*1 acs

puatO 01 kl a r:kZiOOUS Ne$1Q wle Ill eSpO{ vFy)tr.N/Iii pelau lc dce t o

nest or dsCOmpoaglun 04 wdula harm numanl or *4Wda you mull IUgillor

itmavehq IOrnli Anacn jr Iormo *Who ► bbxaly if you Owe Mort Iron&0larw yo~can let, ri nlyr,anOrn cUmpula, raps Cab g16,324-i26?aor

lNcrnalranTha Is nW a Panmll ApMcabOA . All Unasgrouri0 Tanki .W be r.tiretr to

IOCW requlalion Some lunkO.Crlilna hnvt illeully bOqun prpptarlta Chec k

win ycul itUal Cuunly DOvernrrwnl lp IWncCr Irioill' l

MOT! . ALL UNDE11O11OUND COMTAINI111 MUST 11EGIITIII EYIN IF STATE AMD /OrI LOCAL Pt11MITi AM IM FORCI .

I Owner

ROCK WE-I LL Cell OQ A~1RN - EL SEGUINWneC• ya .- Amino

-1Z..10 FAST LMPL2114L II 411►ly

II P .dlltyF .wrw .

MZLMf-TDJ N F_ SSFL

Year of Mf g

Oa7 5L° c4i d 6.441

iVEA G'/tie# L(JvaQ71h. . . .

66x 3 C P►NQGA- V

III 24 Hour Emergency Contiet Perso n

pry+ NMrr ir.n n.n.e vas aw. r•r .w . . .Y p.o. .

s~RV~ct Fitt UK DIS-314Ngr.,e 1. ii.l .remr• wu,- hgn .w .n. au .

•ZIS I

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTbJNER

IV DeapdpUon

A ❑ o Tank ❑ e Su ai Lepoon Pit 0

B Manufacturer (111 applop(410 )

pi . . tw coo. tw n turn. .

18 18 7 1 D 300 DoI Motor Vehicle Fuel station W6 olner'C1CliRtr M~e$

lik . d T .r. r n. Fii i, 1 _IhwM AteM . . . To.+arw rw►r a.c.r..

rP,r oily

D Container Capacity gallons

I LSECi O&/ D CA 9424 5

W . h E-- 7 . STASMrwl Gwn r .a

V4 Ile V

itar aw

C.NDC PAQ_.k. A IZ~4

C..isi . ease. . IA .w .r• A w I..la.. nµJ^ ~^• ~ .

- E 4eP 55F

C . Year Installed.Unknown

Container Repairs ❑ o, None A m Unknown 0 o3 Yes Ysar

F. is Con ta iner currently used? X'ol Yea ❑ m No It No year of last use ❑ w U nown

G Does trio Container Store (Check Orel („r Waste O rw Product

H Does the Container Store Motor Vehicle Fuel or 11100 ❑ .., Yea

V Container ConMtruC* n

A TMCkness 04 Primary Conta,nmrnl ❑ Gauge pinches ❑ cm . . .. 0 Unknown

6 ❑ a+ Vaulted ( LOCalea in an underground Vault :) ❑ w Non vauheo ❑ or Unknown

C ❑ ti Odubit Walled ❑ of Single Waled ❑ ~:i Lined ❑ o+ Wrapped Ox Unknown O w None

U Dui Carbon sls ai ❑ o. Sts-ruese Steel ❑ m Fi tlelglass ❑ t Polyvinyl Cnlarde Orr Cpncrele O in Alurrwtum

❑ 11 Steel Cud ❑ m Bronze ❑ar Compowte ❑ - a Non-rrwtawc Earthen Well s

❑ o Epoxy Lining D w Phenol ic Lesrrg Om-- Glass Liming ❑

Unkr.eC C .+ Unkr.Jwn O w Olruer

Clay LKrn g

F ❑ Nc" elnlerlr Wisp vrnyi w doom D - CalrloO.~ Pluteu,rrn ❑ ,. Ure:nOwn 0- . Nan: ❑ vv OThel

O i Unknown C .3 Oliver

HDMSe00106377

{L „vi P P+M

th, iikuc rcn 1c. IV •H yua .-uiu2t71 vy .rluo 10 t.+n(" av-l .vq`

P .pii r Repa. s ❑ . Nora •, unknown ❑ . 1'rei wear or ncsi ecaru ra;,av

O, vra,.al ❑ . 54oc, ina,rrvorv Q . Tae Oran ❑ . vaavSew NVIS ❑ w Strncw -n{I?umdrll

V111 ChemlcalCampoaltlon of Mat.daIs CurronVr or/rerlourlly Stow" I UnIM►pround Conlatnrrr

1

1 1{ I 1 I I I J 1 I I ,a~a r, r,, a:21 1- r~Arr

001 Om

❑ o l

❑ o .

❑ o,

v . IIIIII II IIII I

Ill l l ll l ll ll l

111111111111 1

061

Cl .,

❑ . .

1111111111 1

IX IMPORTANTI Read Insir,.crlons detare spnm p

64 nu, w T1* Ir.r muw W ~ Qnre oy - ru-c 001 utircl .Y an,cm al I :N le.e, u1 +, .:t Pe" C", a, D•, In . Ina .q 1 layfw n. i ae Thr reuetamal .

mu31 Of riipyltldt To IN vNPiI 3ow / I,O'' )1 it's iac I .. rwe Ir ldrNoL , ark K .i iva 21 a'x'r•Mal panher yrop +al s Jr 71 : i P"r 'CIPrl ia/Cw . .e on,cer: . :.

,iNlrlq e1IC* y1,c,al or ►r'ihn,ilto ropeuertas . e :A a AuOK nCy

Trove lam nu o*i1 compmec .noi. rhi per:aay 01 Dirl .ry . nc . IC !Pi 6iir 31 My hmoomiOe it N ..i ino C7r1ecl

it v. ...r ,w,,.

~18 7~~ ~S7 z

a don fanny, rK mare Irronnaroo CAN II&A24.1211

HDMSe0010637 8

A As .x:a+ao 7 .~,,rjL .. . .

Ar,c. h.:l, jfour-0

E unoerQrou no P i.ry co ; C,ri .av 0 „ Presi,.ra 2„ S„cr .cn

2t to

VII Leak DNectlo n

1 I I I IIII I11.1II I IIIII I I I

IIIILIII1111 1

II I I I III I11 1 1

11111I I III11 1

Tr

C jr*nown

P+ . . .. aW

"W Mc tiazaron wif Suttlarra Slaapu Slalarnr .i Slily waw An cea Cjnucs Bohn P 0 ra. 100 S Cosmmo CA 95W 1 a I00

ooiclal Registration For m

Cwfoml. IM .Mr 11uo urle.a Control Dowd

Hazardous Substance Storage Statemen tWho tlrln FM : Each pwsan int trig nalsldoul, su0314rti ns , n ill" u 9cc

91"" C-v n .n6311au Iios Inm no baler man Jcar r 1484 ( AIIY1 OCkl4W

I . 1"A rp nu Iate. Inary Janua(y 1 1985 tor janks 6sl c on Isrmil

0@15041 3 off Y . ogto.u.+ CaAGanaic The Id* APPMVS ru Co(k•rrlil

~. . jumps 1vu)i,oilleo Cuoeo Ianlii s or ul'lr inoer9touriC cunhe refs ( Water .

Cuoe secliGn lJ173i All cGnlarwri •rcIuSrlyvjjnd(IwilkM PAi, POrds

lagoons an0 3umos treat we 04:14111« Ent 1101n,111 J, Jur,d bult0i: c isw 41091

t nct uo Canlau MS r aid . i%.. nd yo?5 Inrryplt111 Cl lyryl &il,rlY On Intl 9loyn

bumaiih Eno SurtkCC . rf ,nCllwleo oIled C 14 u1i?iwi pos Iwnosand 49001,14

site Cov04ed ?l Bann na1 peen fomovto 111,11 In. Sldraye d(e0I C, C(NIW uCI

1nf llCkay No.n101 pfad,ny ; nor CGrLU.re17 CJnyi, ~ .I on- 0F.4F yi0 -rid

idvdi

OWFAVI on a H%go1af0 M SMd.lanca: Any 5u0SlanC41 ',Sledn SACp on 63112

of Inc L4' tk4 Co i .r . n Secdorn 21,316 04 Ind Flealm an.7 Saboty Coos Trim.

a1Cl1rdf3 04LOMne , .SSSI 1u&1 . all .nduSlr,O . 01-10. 04 1,00415 1 1 :.055

and ium, dN3 It the maltll .l mua1 Oe cdl e0 UV Al neyleleleo naukir 015

posed of al a nazardou5 i001 4 wee ,3 a >< .0S,ve Verwr ates Iueok1 . e 0 o to

Meal oroetompoil00 or would n4rl1 humans Or wad110 You mu3l 1rg1001

Ins lank wastes and vicl ."ed

Fee' Fa ea Ch Will redlalelfd a flu lee mwl rx Q. AAcep Mao rated .gasoline Alal'ons piny S.. pw Will

Mr3rie~s r . ,A,1ure 10 I1 c irw l e sky s 5500 fS ullC Per day d voi, Ears ly,nlprnld6yn rl,u C/n no lirr44o .i Ii $200110 lot oacn day Ins rt110rmlIon ,1

incpx CCI and r1JS not (Ieee c0fly h10

COhN/MYWiy:l rau ha-a- nrlurmakon ivolecled Oy Iride t.Cri" laws

ladas~ .limn a IISI 114 Ine uiloifl.ion on IhiC Olrr. Indl i9 conhoery,y Inc nf .. . .

tusiewalldn l ot COri6oentrarny nCluorl9 tPeCAlc C .takon . d relevinl slilu

tolyand Cdle Lm *

Mulli pte Contained: z,y I Arid II ,r orw ic . m and IeavY it olnr, on all IS

rrmedlinj IGrmo AiIaCP an 1-n, Io{ ifC, SeCul, iry Il you 0wn mdd irwn

0) tam,, you can lim nlo,rr~,rQn or1 cumpurw tape Cal 916, 324 1292 crWJvinaliu n

Ths is 4/0) a PMil1 App*Caeorl . All unper(/ rduf1O Tanks will de I, 4CI ;o

kicai rOQe,aGdn Some lurr3o,ollufe nay . i ttadr tlliqun pfoflralllf Chock

will V" kA.4l County gOVennrriSN loi tumor ru oii nwnan

. . . ..NOT[; AU. UNDILIIOAOUND CONTAINER! MUSTRIOISTIR EVEN IP STATE AND/OR LOCAL PtRWTG AM IN FORM

UCK W .41. GD&('OR QI O N - E L'% U1VW3- ~ne .n

2 2. 30 SIt4ST LMPeQJAL 1.4W'lCn

SLSE40VOD CA 9024 5

II F.1cl lt yF-" W.40W

1k ft.ETDJN E S LR

nonA. .- . WnVr4 ruw r,.rnslrr, a(o .nn.r -, rn ~.

I#p.8TEE1 wc. sewice4 Flap. D EPT ass-3,4 -IiyO . WNW IWY ( 411X ? , 4Y . er1 pr-a . .~1 c os

- 1 35COM~TE THE FOLLOWING ON A SEPARAT9 FORM FOR EACH CONTAINER

IV D..crtp i

A ❑ o1 Tank ❑ os Sump 3 Lagoon Pit of Pond ❑ w O1nerC. .1-rrW N ,,.ut• b ryr 445,0., -, v aw.' ,

e . FAanutdClurM (d appraPrlale).- Year ol MIO. . C Year Installed: RunllnOwn

D ContainerCapactt*w gallons 0 Unknown E Conlalner Rep airs ❑ o, None of- unknown ❑ m Yes Yea r

F: is Container currently used? /o1 Yeti 0 oo No It M . Year p) last usu. C o. Unknown

0 Does the Container Store (Crack One) X. Waste Ow Product

H Does Ins Container Store Mot or venial Foal or waste OI% O . Yes / •• No II Yes . Check appropYYls boatse t

❑ al Unleaded ❑ w Regull Clw Premium ❑ w 01ase1 ❑ sa Waists OIl ❑w Omar (Lilt) r-

V ConWn.r Ca wucYW1

A Tn.ckness of Primary Containment . ❑ Geugf :: .of lnches Cl' cm ❑ Unknown .. . ..

B. ❑ o1 Vauaad ( Located In all /ndergroundVault I I- Non•viulleo ❑ I„ Unknown

Oak Non eUnknow n❑ n - Wrapped ❑ID ~coSiri Je WB N1 Double LinedWalle daC ❑ Vv

o Flber Concrete ❑ a Alurf11rlunl/-yvlnyl CNor ,de[3 a P dpassSteel 0Siarrk e0. 0 o 13 w so1 Caroon 511061

13 at Steel Clad D .e Blonde ❑ oo Compowie ❑ ,a Non- metal lic ❑ r r Earthen Walls

❑ ,2 Unknown O ,3 Other

E ❑ u, Rubber Lined ❑ s. Alkyd Lirorrg ❑ w Epoxy tun lg Q ,r . Phenlwc Lining ❑ A Glass Lining ❑ w Clay Lining

Unknad ❑ . Unknown ❑ ,n. Omer

i" ❑ i•u,yi".1raelrte Whip ❑ ~ V n yl W .;,PH .ny1 U ComY3o„] Protw.:iiun ❑ . . U1 .nhwn /- ; Nor)u ❑ a O!hlln . . „~ ~ .- .

P.rar . (W .,.w 5,5(.11144

C... vv :r. STIRS

moo:: AN o

..rya¢

Cl ,

y,Mw . 4pf.{

i(oa3 c P OGA AVF~uY G° CW

CRMMA.PAR.IL IA0411Fa, . . rw Ow.

95115 710 G100

ww a ° - --- . .

❑ a Mo ftraAi~or verode Fuel Station , Mq011"w"

44.444 . a T- a air 0 .IIwM Miles

T wrwy. rWy . . Sl ,na ..

3 7 TaK KS

III 24 Mow Em.rgency Contact

. .. . .. . .. . . .. . .. . . . .

HDMSe00106379

A Assoc .aled Plp,rig : ❑ ,i Aocut Ground 6~ Underground ❑ o ., Vaulted

B Undergrourld Piping t5aw Gravely ❑ v Pressure ❑ m Suction 0 r Unknow n

C P,p .ng RopaIrs.--- 0c1 None Unknown 0 . . Yr. Year 0 1 mo51 reCenl repair

V11 Look Delfaclio n

Visual 0v: Stock Irivenldry C1 i, Tile Dldin ❑ w Vapor Sn if f Wells ❑ u Sensor Instrument

❑ uu Infernal ina(lf:cson 9(w Nun n

VIII Chemical Compost ion of Mu11ir1614 CurrMUY or Previously Stored In Underground Confolners

rW/wnry

f

Mw 1 CMIWN (Xi ti u I/ u• LLV i•uu ~L J N .u~ . Iu- ak .o ,a. lw{ U lu nMX,• r1~M r

01 ,

la ~,

❑ ru

❑

rofA*r

rfSLR . 1 RISC' NTJrES

❑ o 0w f~1~/TT Q

❑ ot_ ❑ 0 2

❑ ol ❑a

0 at ❑ or

❑ 0 . ❑ or

[lot oi&per 0ce

pot11 U,

lit. rhUr ruin ue lu lY - r1 uu urc nut lUUuuua lu (,umplulo Ihib sucuunI f

Is Conta in er located on an Agricultural rarm' ❑ u1 Yes . No

IX IMPORTANTI Read Instructions ttetore signin g

ei9nalura7 The tot rImull DO &pn6a by I, a pnnapel tlxtiCGl rve ollcyr at trot : Ieaei ol vice-pras.acnl or by an hulriorl2ad r epraaenlalive The #oWesentallva

mu61 be raaponilbk fin hr oriel all opelalien"or Ire IdClllly`wnela the taflklil are located . 2) agaNlal gannet proPllatot ; ot 31 a prncrpal aA•Cullve o111cer

ranking elected Official or aulnorltetl aepleaemallvc ol a pudic agenc y

This form his been compreled under the penall y of perjury, ano 10 The best 01 my knowteage. Is hue ano cUliect

T ., Peurw ter Cs.

land Otwph w Hazardous SuoatanceSiolapo Statermnl State Wafer Resources Curnrut Boatu . P C Bin 100 Sacnnrer110 . CA 95BOI-0100

enw h oo -S--;W

For addlgonal forms or moll Information caU 616/324.1262

FOR STATE USE ONLYID lr.nxw

aw Pw, . wa

ar r ..ry M •0 IVUiiGr

0 Ll

Ln , rw,nm.,

a4 U647

HDMSe00106380

Fmorl EglstrallDn0lIlcla _ .C .tttorrAo Wow Releowc•s Contrw Owlyd

Hazardous Substance Storage StatementWho m ws1 Para Lacr. persun 21 na .uows s~prur~ lrn in any urwcr VN Yi* KAUrs alt ,larder

or"" Conine ' mptl l.k firill, iorm rW late, Rran JWV 1 1984 IAlltr O[nwer Feal Fw racy lank( , iec ■ 110 fee marl w pW SICep vial 11114

1 I get, 1or IknkS ~BHa on larmll - . :Q.War1r stahonk pay par vlrw1 F98a and rr l4 Inyn Janaai y

Dkllarlbn ad llnerrLroWW CanlWnec$ Ink 11* appiws to Cbrlciely PlariaM11e Furadu,e 1oIrerrlepeMnyiL3500•$.0Od pernoyiryouIal6rly

: .. . . ~, wmpb nortr. tli a L,( .C0 rMS 01 orha' urloelpnCrino cunla' ners 1 0 IIN "Curt l rrr your ton be Tinto up 167,2000010 oaCr pay IT* Iraormafon li

rl ( M d ddps Oin, NA r s in[(}1eCl } no has not 0511 CwreCled . . .. . .Ciloe 60C1'r;rr 1 .4173 All CCrl4 rler6 irlCluulrry M a

ale cover ed it etrln has D*er , removeo lion, Ink slo " IleA ' [dllk ruL Ilil.}nd Cab. Wwd

rp,6ler A tar. t411 n6 on lne W'-'""-' . m rld 9nC r ' ► y (Maaku Olt crl rllal of Iht• Irlldr rtl4aun dn4h,s lam trot is CwYpenly . iryp Inv

beneath In. 1,1.c, .,e nZlutllyd lir>fa ~, ufll~r .,.a WS panetirld W(IUC,r11 pJ I,l .calydn 1w Contlikl rally irbootlrngsp*CAi1 Cllaadrla ol Ialovaf slam.I

ytron prdeCled Dy tlvpf reuN I&wrylaprrd,s &no sort pY If.al art [reluw V C4Adiafeallry ; It you n}rN miryrld Conlaarc•r•tr11 al

111E rwrnlAl ,Juno uorlaic lerpl may '

Inv IACady N0,mal gr}ornI 'C not Cuntlolelir CUnsu-Loon ON w Wuw te

it-illDtenleon of MUlara111N I .rbaunet' Any euo6lanr.d IIrCeC r, Secl,on 6382

oi Ins lawn Code rH 0 Section :L' .]1l 0' 11111 1ltalln end Sal('1y Coda Trr elrlduda5 ga6o6ne dieoel I,nll an nou}4r,6l 5dlvrnlb pe6llc .de1 !`WfNi :,deS

ono luml6ynl6 11 1,1E 1 lellal mum Oil, can as 1), a leglsleled rLau11M OIS

POW Ill }I a hh24r000S slash WIC I6 d.)40s,vt perm dies plrbbIMe ou<• to

natal w CY[dmp06il,un of would nailn numan6 0l wadnle yw mu6l ,OQr}il r

oft, a.m. ru., rw.n . vas rm liw-a r .. an.

ETIW- SeW1M5 nQLDffr 611.314

MOTE . ALLUNDLRUROUND CONTAINLR0 UAT REOI1TIR CYMN W STATL AND/O# LOCAL PIKRMITLAM IN POP=

I OwnerIaM,Y .~cC ann. ,rtl .o.,` 11 Y~c Ae /K., ~

MDM W EU. LNI_C'ORAQ"1 D N- E L "5EG UAI[1DS." Amn a

2L 3d IikST rNPBQ.IAL Ir'~ J

11 F .cUlty

MDUtf-TO.Li N E X5 G

C . ,

t~LSEGUVODr

C A

W .-J. Co STIwS-rrr,w, o.. r'rr

Anne.L.

$s ConlWlerr: (Al an( 11 on one Iwm and hart 4 wank on all IneWaItrn}llnng forme AII}Cn o6 lorrra Iogelrler list[ .%5Fy II you own mwl' IrLan

50 larika you Can IMAua0lf'rij on Curtlpuler IAAa UN l16132a 1262 Ict

49prmlUUn

Tn11I. nW aP,nm4 Applearlan . All Unoeryrouno Tank% aaa ne sooecrtOkxal ruguralronSortie IWIkd .Clion6 r,avs enaady ndpun pvopiams Cnd[~

VAn your k ni county QovernrnarM t0. IWlrlel int0ir11.On : . .. .

hq,f. 115111 M. rirrl. „ll .rb .,. .. I ~IL•. cul t

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

IV

Tarr. ❑ o2 Slump ❑ a: Lagoon Pill or Pond ❑ .. 01

B ManulaClurer ( 0 Apprdprlete .,

p Cornainer Capacity

C-kkDC PA Q-1L 15041yaed akwr,ta `

❑ o, Motor Vanlcle Fuel Station xL Otrier'~fiTht

Yea' ol Mt g

❑ Unknown

C Year Installed . 1s ❑ Unknown

None If in Unknown ❑ in Yes Year

F . 11 Container Currently used? ❑e Yes la No II No year o) Iasi use ❑ ou Unknow n

G Does In4 Cor4ainer Store (Check One) ❑ o . WasteK--

Produc t

N Does the Cornalner Slave Mow( VeInClo Fuel or Waale Oil? ❑ ,., Yes o It Yes . Check appropriate ooa(ee ►

Other (Llat)12 or/+VA$/ -6g& ~❑ w Pranium ❑ w Dwsel 0 e . Waite Ott Q

V ConIan .r Conet(vcYOn

0 Gauge 0 Inches ❑ cm $4Jnknow n

B Q ei Vaulted (LOCJted in an urloergrourld Vann )` Non veined . ❑ o5 Unknow

U Caioon Slael ❑ mSiarnlem. Sleet 0 i.l Frbblglash 0 L. Polyviny l Cnlorloi . . . .. . C Concrete ❑ is Ah%YWII.A'I

C ❑ 0,Doubae Walled KviSrrlgle Wadrd ❑ Lmed Q a Wiapped 0u Unknown 0a. NOn e

Sryaal Cud ON Blume ❑ w Compusee Q lr Non-metallic 0 . Esnnen Wall s

611 /

19 fea3 C ArK06A INV1~-lAi Aquila.

18 710 3,0 0

rAKKSzipIII 24 How Elne► p.ncy ContSCt Peron

Ur111nedXJ u

nk now n

F C . F1U Clruerlt Wrap Q . V,nyr Wi opping Q . Cnlnud,. Pluld1 4Jn X. UrMrl0 wn ❑ ; : NOrle ❑ w OIrler

21

C10245

HDMSe00106381

VI Piping

A Associated Piping 0 ., AoovO Ground ❑ .r Underground ❑ o Veulle d

Underyrouncl Piprnq yGravdy D o Pressure - . .7A o3 SuCrion © o Unknown

Q U, Visual Q or Stock Invonlory ❑ „ Tile Pram ❑ w Vapor Snilt Wells ❑ o Sensor Instrument

❑ u Ground Water Monitoring Wells 0 Pressure Tesl ❑ e Internal inspection inr None

❑ Dlnut - -_

VIII Chemical Composition of MAterIMIS Currently or Previously Stored in Underground Containers

.u.,nwr

aC

rw4wr ____ Ca.wrcr

YOU

,rri cw~. .ru .,r wl 1U. L. nrruruvi

❑ o . pm

po ❑

❑ or 13,w

❑ 01 pea

Obi0 -

Our ❑ w

❑ o . 1302

Is Container healed on an Agricultural Firm' ❑ . Ye s

IX IMPORTANTI Read Instructions before signing

INOnaluf : The form mull be 6rQ460 by 1 i 11 pnnclpal e%lCWwt ollLA ar the level or vice-pray oenl or oydn aulrtwu ea r spraoernaurc r rq raprasvr . on . . .

must or reapons-big tor the overall ope(aliCrt of me aCil l where me Iaruilsl are keeled . 2) a general parinpr proplrelorl or 31 a principal exiculne OPocir .

ranwing aiectee official or aulhorizee rep, esenlCIek of a public agency . . .

This lcwm has been completed uneer the penally of p.yuryand to Ihe best of my krruAULge is true and correct

Fvrr.U tym. fM nraw rr* .a UVL

Mnd shack to : Htlardous Substance SlorageSlalernenl Stare Wale , ResowceiCentol Bond PC Box IO0 Saclarnenlo CA 95901 .0100 .

For Mddltfonrl forma or merit IMormabon orll 9161324-1262

A,L- .ly ry 11-

C Piping Repairs ❑ l:r None Unknown ❑ o, Yes . Yea( of most recent repair

2.3

VII Look DelecOo n

UM r4o .r..a

GkeO ek W I V ~ H uu arc nut leyu il uo Io l .onlpolr 11110 Sucbun11 h

Pb' rl Ii IC u-r

HDMSe00106382

OtIIC a! ReglstratlunForm II

Hazardous Substance Storage Statementoter.__ .I rill . Wr .alert . Ju Hntrol do.rd.IM "" C

Nara Marat Piss: Each pal On alarm hi r0ous suouarrt-AS In any unau me Ills waalas ale rlcaroad

pru ai0 cotNa, nli ML61 l ilt thus 10rm rlO lain Inafl JWo I 198 LAJt r Oc1O6ul Poo : For t cn lank r e - ro ■ f117 ree rnu111 W Poo *. .AV Ir1Y inlaid

lr baltl r+n larmbfi larW5 tfi $y.o y ue p906 .rw alalvoni pa yI IrrN ono -o later than Jar Wry t i

raYOn M LIrldaryreMl d GOlllalllalra Tnt I . &(1(0I1 10 COncleIC rer4 4 F CN 11Wule to hie Iha lierINo ► L50u. 15, pOl aay fl yuu lalsoy10 s 0O(0 101 U Ch Wly the rndr1111501 ILlflO GJnik~r, urL (watt, IulrOn 0C u(.informal on yDU i .awrrpll nor- 1,0 r"' .60 lna1 0r CPub oooel0 0

C: Lie secii ur. 1 ;11.7 .1, Ali ccnia, rklrs ncl.011l LarlhIi , waaeC oih PO1d1 .nC greet Lino ha t. nut Le aln CLihnCiCtl

S "t ono Lumps Inal are De,(rw Ine norryl pIJul,O ►Unal( ,rue rrratta if Dy r1N .d N,IWn1a11M pldaClC-p lily Iloos NCrl1 is f.r

Yi.10, A ire Cil,ng on lilt QruJn0 it nu rncluo(e0 Corlla.nn' f+arlrall

,d Id " CN1ykll ►c allaLh a lift 01 The nIOffw I.LN1 on hrs 10M, trial d CONW!'111 . alto IM

rO .Y :A1 Air, Ih( SuYIN (r" hit.' kkleO L lht0 or unhr rl.1 ► DOn W pusioK ilr0n III COMrOrrllllµly rr►:lucrIg 4PerC,I CaabOrls 01 rtllrarll 11x01

un t J nrA01

1 Me COvere Cl if aarlh has Diift.' JVnwaO lloni 1nt LIO AyL area l~ Cluny ono case be

the IrCJJy Morn Wl 9f .0,% , 1101 cun4Dele0 CGnslru111,00 Orlow wUUrWlaurupM Conta4 to FAIL 1011011 on one lam ah010000 it OLII1t On ail m e

4vN rtmA,rl.ny ICx mS AlI11Ch

'IN

iormi IOQr1Irwr GYC 1(tI It you own rude 11 110

ly Chon 6x112 bU Iarwa you Carl Ise a,101n, hur , on CCNrlpuiOl lief Caa 516,121 1262 lpDefir

l of

of I n

Ina`

11

L p

101

DW 0 Coot

ootr M doua clror rlpa Any Sur -l0lllh 1 toe 0 In

in $OChOr1 016 0 Inc C81p, antl Sa (' Coo TrN ►avoonallun

AICIuON, QII ►Dent 0.e1w1 fuel aa . Inousil al sOlvtnls peti C,OCS hrrbrc,Ou ►Thai, M 101 a ti1'1aI1 APprOaaien . N1IJnOrJlQr0u110 Taruf .+ratx aWrarCT IO

am iurnrpanls it 1h t 11 .1041 must De cwr-&O Dr a re lrylelsd sawn 01 s

pu► eo or r/1 a hY011111 5 w► 3le Wit 16 e.INOS,vt Verret Olts preS ►urt oue tolocal rep,ahon S0111f IWr►OrCl10rls Aare A, TelCy Oegun prOggrns Cnock

,rlw ii your "I uunly pore, m0nl 101 lu 100 , rrvO nwl O rm Dllo l p, u.

1000 of ducOmp0511r4r Or w0 .00 norm numan► 01 weaNC y

MOT : ALL UMDE11011OUND CONTAIMEIIS MUST III QIITE11 EVEN W STATE AMD/O111 LOCLL1E11WT6 ARE V FORCE:

I OwnerI►Mrr icaWa W AArncl I

QDU(WF-U Lb&f O(LAQIDN- EL SEGIOMW

22 3b EAST I .NpeQJ RL 1,+w LsE&OUDD CA 9024 5

I1 PacWtyrr .~r sir, .

R WLF-T J N E 5'SFLsir. Aoo. ..

iba3 C PIrNO A-MrVF-rr.r. . : rw L

8 i e 71 0 0300grate a , ar. . In 0w law

3 TA►KKS014111111110

Drat

A, bS (fl M rrl,m.• 11111 rrra 1Wr w 5011 Cap,

r Its. St~0.VIft.SFIRP. Derr s1&-3'4 ZMS 1

COMPLETE THE FOLOWING ON A SEPARATE FORM FOR EACH CONTAINER

IV D.scr$Ptlonr

Conclela ❑ eL Alumviurp

❑ to Bionze ❑ a Composite ❑ , e Non melaSlC ❑ 1, Fannon Walls

~ " ~ rrF r~~uess

D wAaryd Llrwng ❑ w Epoxy Llnng ❑ w Pherootmo Lawny ❑ a" Gi1111U' ing ❑ a Clay Llrrn

HDMSe0010638 3

A . ❑ o, Tank ❑ Ir Sump u~ Lagoon Pilot Pond ❑ w Other

B Manutaclurer(11 Spproprlyle)

F~,

p C. Year Instsued C Unknown

WryMt- W . -J. %T .̂5

Nw~M IMr

tw

CANDGf .PAQ.L A 19 1 .9 4.

/44'

Q, Motor Vahlcle Fuel Station OWL ORIer-t r6&- -ROZZE M OTM,

Year of Mtg

rsr ar,mt72 "-doulons ❑ Unknown I E Container Repairs Do, None ❑ or Unknown ❑ to Yac Y"Ir

F . Is Con tainer Culrenlly used? ❑ o, Yes 'w No It No, year of last use ❑ w Unknown

a Doeslrie Co nt a iner Store (Check One) J . Waslo ❑ m Product

H Does the Container Stan Motor V5rilCla Furl of Washe 0411 D ., Yes

❑ or Unleaded D w Regular Q

., No H Val ; Check approprlale bosiss )

Premium 0 w DieW ❑ ee Waite Cw 0 as Other (Lilt )

V ClonulnW COIItuCCW1

A Thickness at Primary Contarrnrirnl n D Gauge InCrwa 0 cm 0 Unknown

B ❑ o, Veuhod ILocslea In an underground Vault y_ $Lw Non • vautled ❑ to Unknown

C ❑ .r Doublt Walled Doi Single Walled ❑ w Lined ❑ o. Wrapped ❑ a. Unknown ❑ of Nona

D ❑ 91 Cerdon Sleet ❑ w StarrtlesbSteel ❑ of Fiberglass Do Polyvinyl CNlxlda

pipin g

AAasocIaIea Piping. Q, , Above Ground ii Underground ❑ vi Vaulte d

B . Undergrourla Piping , Gravity ❑ , pressure ❑ ov Suction ❑ . Unknow n

C Piping Repairs ❑ w None d 1, Unknown ❑ e Y Year of most recent repair

VII Leak Defection

❑ w Visual q u- Stuck Inventory ❑ r, T .IeDian ❑ s+ Vapur Sniff Wells ❑ o. Sensor Instrument

0 rw Ground Water Monitoring Wells p Pressure Test ❑ v internal Inspection

❑ w other ,

VIII Chemical CornpoaIIIOf of Maft► rlala Currently orPrerlouily Stored in Underground Contrtn.r.

11 you Chuc. kut yos lu I V-H yu u ale nul . Teri iie i i'umplrI, aria ucb .m

iu wYw..nar MAY _

:Orur.cal V . her Il .r Gu ngiC •Y R.✓. . . TuW pYW W }IdI H 4I muvlPx~

MWYtl O~.a • 1 .4 Ynnvrn . .

> .rrarx

❑ o

I I_II I III I II I I❑ o .

❑ u r

❑ ut

D o

D or

poi

O~

IIIIIIIIIIII I

I II IIIIIIIII I

is Container localeo on an Agncullural Farm? C] Yea N o

IX IMPORTANTI Read insiructions before signing

I{Ipnsture This form muss be algnedpy 1 a pant ipal ovecuuve officer an the level 01 vice- preudenl or by an sufnaaed reprasenallive T he rep saenlahVe

muss be reiponsible to o the overall operation 01 ma laCdlly where Ina lanklcl are located 21a general part ner pr Oprietar . or 3) a principal ekeculrvy ollicki

ranking ewcIsd OIaCIBI Of aWnaifea iepreaenlaltve of a pudic agency

Thu iurrrl has been completed under the penally rA perjury Ana. to the hafil of my knowledge : is true ands COnaCI

hwra IWPwr . w/Y4 V,

{end cWVk te : Hazardous Substance SlorapaSGremenl Slate Wale' AascurcH& Cxord Beata P O Boa 100 Sacrarhenro . CA 95801 01 W

For addlNonal forms or more Inform atkm call 91S/324 .1763

FOR STATE USE ONLY

S4 31M7

HDMSe00106384

th IYCddy MJlTl gl icl y ts n(A Co .s.0ele0 Cunalrucllon oe10w grlwndMi"ple Contallrra Fil I Ono 11 on one form ono leave it swank or, as Ina

foft Mlasi Foe Each poison atp .n0 nalatOous iu Dalar.Ctrs in any uedL - fhe salts Agar" a,# Inu.,afa

Vuuna conIMrlar -tti lit lny Ism no late) than July I 198z Altar OCICO41 Fes : Fo, each rank , 9. lelrlO a $10 tae mall he pad axcapl Nil ruIll

1 1984 and nu later Iron January 1 1965 for I11fMi uLeC 0r, l army QSMwrte Ma11 0rli pay $5 par 111^1'

YIIOe M UrIMrWolma C iiielller >t Trw iww appiwl lu Cuw1(.laly prnealew for talule to tilt 11* pr"Ity is %500 15000 par lay hypo If1 54 y

Iiw*iPi nonrrulle0 Lul .r0 rdr,i o, 01nt~ un0olptuunC Lunli .ne" ( Wale' vppmjt nn you can pr tined or, to 120000 for each pay IM a$Ofnlal.On is

AWLCuoe ytCtorr 1 3172 AII COMiorleti riciu'}n1 eantic- wa4id r p01 .01 ncWtucr Iona nab not LoeIr. curINLIL`o

l

Ottlclal Registration For m

of the Laow CoOe .M In Sector, a3I5 of Ira r .talln ark? Salrly Cuoa . Tni - . . :Iowa mMiOn

,imailw

. iarw.y you can lilt lrwur nwtl.[0 On COfnpulel [Ape Cal 7161324 1281 Ipnaa/Vaer10l Waaarloim It 5iwldet Any suGilance prtl .n Seclron 6782 rttart m ; Attach 1111 J01ms l • olklnCr irC,N .IIY II Yo .. 0.10 M00, thin1(ivM n

/ICkldes one O.ebMl luei all tn3uBli,al . iioly6nlb C>d Lllc .dl`s ri,O.c-005

fn0 tUlnigantC It the r•Ialerial mubl tom La-i0 Uy s 109io1060 r4414r Fhh TM 11pla Fierallt AppapaYori . Al1Undergr0Ullp Tanks saa Oe[WnreCvI IOL

r

puiCO 0I aI a nrkaroous waste Clue is ekly0s .ye Oene(IolMS pleikule du.-' to IoC11irtgwalion Some Iully0.cle' have YIrea.7y flagon piopamf N

_

lLltlfwkhyowl bLYI Cuunly(10va1nlTMrn110r IWIr1er uwpn'it6[11

Row r rA d pl Cyoumnumyn60 wd:' . neat or OeC0mp0Yillon P*01i0M1M r

ROTE ALL UNDEROAOUND COWTAIMIRS MUST RE GISTER £VlN IF STATE AND/OR LOCAL PERMITS AN IN PONCE.

I OwrurItMrw,(AP~r{+ npr 0 rrdr Mlrrr L

1ZDC-KW F-IL11.11« 554141

GNI t'ORAQ t~N - ELS~GU~IDD ..=tr

,,

l3EGUUDU CA 9024 5ST = MPt:QIRL LAW l

L

3b II~ M'

lit LOv(9 ro d earth ha 60een tem0ve0 r) 9 lury11W Catty 4 w

1 (uudlcal0n Ia conllrarw . futy ILO g sion rc .C. . . peAkhI0 Ina Lurlycr are nclu(Ieiy ld*tl ur Wd ✓ .e0 Rib c Io .

I R Ina iltlla L aleIo to Con6tiucl

tram ae[1ly aw1mumColmikiedLe n ly_ 11 you have 1Noiln.Ilnn protected bylag00ns an0 sumps Ina1 an' D uIt* the nOr'i*l g-,.o Lunacc IBre

I Mev A IBM awlrn~ pnIM g, 0un0 rs nor nclu0~•0 Conlai+N'is p..rliIoFywas~ illrcn a list 01 the intoiRilrCn on this form Iryl h CW11oerll. a1 Ono InY

r ntl Ia s i da0rn or yatarare Llalu-'n

C.111ornla wow l wlwcea Control boar d

Hazardous Substance Storage Statemen t

tZ2.

II Fa oM 1t yFacrr w.r.

IZ. Jtt-TDJ N £ -5 FLM- mIcii .

O Gauge Dlnches ❑ cm Q Unknown

ww ~~

`(. 3 C APOGA• AVF GNDGiLhARJL +1 1104---------------

D" . "M 1111/1 nuru Yili am ara+w Iva. d.i r

kATwTIK1 . SERVIKS AQ t Derr 516494

L- W,7. CD STIES

wxM

h(/e.. Nam la"'4- iS, u.o PwM • iii- . Casa

COMPLETE THE FOLLOWING ON ASEPARATE FORM FOR EACH CONTAINER

IV DOWAPUon

A ❑ of Tank ❑ w Sump 4eur Lagoon Pit or Pond Q w Other

B ManutaClurer (ii appropriate). Year of Mlp

Ir~l~.rv rlt~aaa~w~Q

C Year installed - nknown

D Container Cape-, ~~- gallons ❑ Unknown F Container Repairs ❑ o . None 2% unknown 0

F . Is Container Currently used? ¢ u' Yes Q w No It No year of ast use

hurl AreasO

0 Doss the Container Store IChscw Ono ) . Waft ❑ a Produc t

H Does the Container Store Motor VehICta FUNI or Waste 0111 ❑yi Yet jrw No 11 Yet . Check approprule swa(n )

❑ it, Unleaded ❑ W Repulai ❑ w PrInIIJm ❑ w DIelM 0 a Waste Oil ❑ as Other (Lost).

V Cont IMr Constiuc on

A Tr>.ckneas of Primary Containment

9 . ❑ oI VauliSO ( Localeo In an underground Vaull .) ❑ is NOM1-vauted ❑ wUnknown •All,*

C ❑ of Double Walled ❑ 112 Single Wattid 0 as Lined ❑ w Wrapped ❑ a Unknown Q m None N1,4

D, ❑ v Carbon Steel ❑ a- Stainless Steel ❑ a Flbwglau ❑ 11. Polyvrnyi Chloride Dab CoeLIIle ❑ a AlunWkl h

❑ DI Serve Cad Q A Bronze ❑ al Compoa la ❑ io Mutt rnsulkc Earlnen Wort s

i . Ostle r

E C) o Rupuar Uned ❑ w Atky0LlflIrIg . .. . . O Epoxy Uning

,o unl' r.o3 ❑ A Ur1knowrr ❑ w 0111*r

I F ❑ Hotyrlnierle Wrap

rurr w 'rr cnw 1.w d

Olney'❑ ut Maor Vehicle Fuel Station )'L al 8 TI d 3d0

3"/ IV(KS

III 24 How [mar9ency Contact Parson

❑ .r Unknown 0

❑ . ,inilWtsooriy

❑ o PnnoirL Lining ❑ a. Glass Lawry ❑ a Clay Lowg

0'.' Calhoo.[ PlUlt1 I an ❑ . -. Unrituwn NOn: ❑ A 0111rr ~ ._

❑ aUriknown

HDMSe00106385

V l rlplnq

paOlrlrr__ .

CrwckaU YU1i l1 IV-H :}a, JIB r.1' W"(1 To .. WM~,1u (r4i .rr~lr~n . .

❑ w Stnsor ~nttrumanl

V1ll Chemical Compoa ► uon of Matwieb Currandy or Prerlauly SloredIn Underground Conlalner/

fiti,U

W

row w, .yrry J4 1 . nue ,oa r

~f3T1/ .4 ~/.v

01- ❑

❑ o1

❑ °r

~~~IIIIIIIII I

I I I II II I I I I I I

0br

Dor ❑ e

❑ ol Os

❑ i ❑ a

0 oe

Stock Inventory p ,. Tile Drain 0 w vapor S611 Ne111 t

Cal . r . Win :. .

I I IIIII I III I

III IIII III I I I

is Corwalr>•wcalaa On an Agr iCL.ltural rarm'r ❑ u, Yea sJ;N O

IX IMPORTANTI Read instructions oelore signin g

2lyneuw: Tne lam mulr oe vN grve0 Dy a u .nc ipal ex.c .mcu Dnd0at vie !e v e of c oripreslaenl or ny en al iriotl„x7lrarempiai,e Yh.r rewewrneb.e

must b@ reSpO fo a l01 IN Grererl opelallor ' Jr me IyCIINy rnwa IT* (arago , ale iocalea 2) .1 y,rarwal parIner plOp4l404 at 31a pnrclpal rvxeculiwe onlcer

rankmp a4Ctep QIIICIal O aulnonZM repiesanlali + a ur a puabc agency

Trot corm nat been c0vTlpwleo under the penany of pwrwy lna 10 Ine bell JI my xnoekeoVt -s true anal turac 1

it

lint! theett Hazaird of 5unua rce Sldap. Slelemeo Srale Water ResaurceI Consul Boma P 0 BI 100 Sai,ramen0 CA958BI,0100

/v ~Ly

r%ar . . .w :..w

For addltlo" Iormear mom II OrmaIon CMI 11117324121 2

FOR STATL USA ONLY

G , r

A A&I.,X . bdp prnq 01 Aoc .r ~N COB uncergrountl iautleo

a u g P •unfl 140, Gravely ❑ v Pruos re ❑ I Suction [7 jrionO*n

C . Prprnq Rep's ❑ None unknown ❑ Yes Year 01 r7 CS recent repair .

VII LO k D`toctloa

C

HDMSe00106386

CoMlornta Walter IMsourCln Control Board

Hazardous Substance Storage Statement ' + R 55 2■" MW P0.: Eacn poison aloi,ri na :araouc suourrWrc in .ny undo, mr larr wawas as a1C,.aaea .

QruYW cdrlams' m1.s11pW m1L form no lale. :r.n July 1 1984 (Alter Ociobae P..- F o. 44th lank rapuafea a sit) lee mull IN ow arlcep 10414 rwf. . .

1 1964 Ono nD ulef dr1rrn January I 6985 No Tanis use0 On tar- QawkrrP alaaoru pry LS prrpfrv.

DoW ilton @1 U"worawM Colualnen. T nl 6 . a(101w1 io C01 - rele PonmSe- F ter il. .fure to hit the penally it, Si sa-$5 .000 Va 06y a yw allay

llIco ami rr.e 1/Ilbmar,On is. . .2 0 Q(1(r IlPe f/ p.hn O uy w i; lees l e er rNaRV•bnn you can b,,Lulmp6 rloricsukp0 Gurreo (d 'US d car, underOrounC Cunlr~

, e„ of yyLrOew yea : Any ,uGUan,_c lbled in SapKjn fi3Ef2 . w tans, you Can Iau uuarraflien on compole. l5W CM 9161324 1262 itsT

* .61 arrtranuri0 lams AIIsCh A" Joirris Iop0Nh4. r ieOUi ttry II you own morn Moil

in Seciron 25310' Of the rruiBh an0oa .elyC.(lea .twsh' if Ct l 1cx M01 the ao.. n pr4laGlX

wtcwdcs aaudrnr p.ebel fuel rp nouwnal savrr>ts Pcrer,e,ius hertik:,dus This Is not it P~ AppYeaYan. All Unperprouna Tanks *A be soWt to

and Ium .p4nls JI the ndlrerul rn-l Ue cVrnrd cy a reolfile4Bd lruler Ol tOCal reo 44.00 $pIT6 urnSO,ChOni nave alleatly begun prOprNnl Ghoek

s waste Pit a ekµac ve yl nrl airs peE .we d~ to ~l nktardo 1lmrlnoupoa~d w a a [r ✓MO aUlMVernrrleNla lu.rdhyoul IGiAI [aunt y pad slim non, . ny yr wddtlC yvVnluw r .19101v r

•

Ot(icia) Registration For m

me ISGddy No, rr.al QC4aro r . not C4r,WOr.eo 0Onsllu11100 DOOW Wound1114141041 ConlMfW6 7 Fill I and 11 on One lolm and ldaVr it IYan: on all Ine

Bit eo bL0 rO +1 damn ry1 r*eT Yemove011 pn Ine 6I0 .avl- area lu Lo,la,uClIWyrre cabef law

prrwrm Ir>r SurlaCl • r[ ~IILlunrd L .n[O co ,rfWflrrd 4.15 Ix ,10E Y rg y 11rald,CLllOn ,a C0nlfprnlrlily InCAUdrSl apaCa,C caak0na 01 1040. ..14 LI .1 U

LDDOOnb &.(j fumes Mitt are rwrw . the 000014 Q, . 111 1una.. 1 WVIO n .usl ~y; it you Aare , nlo.mal ,M pra.Clte by Iyad. MC'N laws

ra ilur A lank slll,ny on the tyfoun0 il flOl ,ncltwiv-d Coolsa .er3 pall-11, Wey5allai.h a Nat N the rntartyl .yr Olt Inl6 loan trial l ft CONrOenlial ono Ine . . ..oclno

, . . . . . . . Codi[ecu6r. 13!731 Ali Lnla .ner1 ncludnv eannun wated tn6 porwk lr4Wrccl dad h1Yno6 Leon CWre0loo

I IOr orCOmpol liuh a wo

NOTE' ALL UND111011OUNG CONTAINERLI MUTT IILGIST&II FAIN V STATE AMO/OA LOCAL PERITS An W FOItCE :

Owner4.o ~Caowr .n .1v.uw o r .an-wy.cll .

P A C K W E .1.1 £ D & ( ' O R fi 1 Q " l D IU - E L 'SSCCG UNDOGr

ISIS AoaA1

CA 902ELSEC%0VD0145T LMPLQ114L 1.4W`!22 3O rFs

t1 ; Facility _

R.LxftLTD I N E 53FGw.. Appti ,

au . .. n~.ar>v A.

C ArN O6 A• k V R C1 [11OGQ (~A e-V-r,,.,,. w • . .4 cum

❑ ~r Motor Vflrucle'..Fuel Station • olnarB I B 7 1 0....300

rr,.W~ a l .rr. .I Nw F", Rural areas lor•+

rVti

37 i RKS

Itt RI Hour Emergency Contact Personw . V4 Ca1.us am /rn'..I .a .resew Iwv rSlt .

-( Grim SERACIE:S RIRP, Derf 616-314

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

IV Duoriptlan

A ❑ o, Tank ❑ w Surnp or LepoOn P .1 04 POnd ❑ w Olrlar

B Manufacturer (if approwlata)

G.rrlr. a .rarw .. w.l• 4 S1'1144. . µ1!. '

P2-19- S SF1~-

- Year 01 Mlp C Yes, 1 181allad . . . . .. . /Unknown

D Container Glpacity-l .LfLC( gallons ❑ Unknown

F is Container Currenny u$ad? '4 Yes ❑

4 Does the Container Store (Check One)

Container Repaus ❑ o. None Jfw Unknown ❑ .o Yes Year

No of Ntl year of Iasi use ❑ CU unt riowrP

Wails ❑ w P( oduCt 4 14 7-rA-

N Does the Container Store Mora Vehkcte Fuel or Wast e 0I17 ❑ - . Yes f(u No if Yes . Check appropriate bOa(ai )

O o . Unleaded ❑ W Regular ❑ w Premium ❑ w D4esal ❑ all Waste Olt ❑ to O&M ( List) .

V Contalner ConstrucMon

A TM-knees of Primary Containment

iyp YrrYMxi.a

❑ Gauge 41nc1Ies ❑ cm ❑ Unknow n

B ❑ o, Veutled ( Located in an urk5erpiOUnd Vault) ❑ vt Non •vaulled ❑ oo Unknow n

C ❑ o . DouDle Waited ❑ x Slrlpte waned ❑ 4+ Lined ❑ a Wrapped L) Lx Unknown Q oc None

D ❑ a• Caroon Steel ❑u Sla•rdesl.slo l ❑ ,1 F,derplass ❑ L. Polyvinyl Chlorrc ❑ r Concrete ❑ a Alurmum

❑ or Sleet Cfad C a Brogue ❑ am composite ❑ , o Non rylelINIC •, Eannen Walls

❑ .a Unknown C1 3 Othe r

E Q u, Ruooar uneo ❑ w Alk yd Lining ❑ w Epoxy un,n9 ❑ .w Phenolic Lining ❑ o- Glass LYYr10 C a Day Clang

T Unlined ❑ ,. Llnknmwn ❑ a Older

F C ., I,oyel r4Cnt Wrap ❑ - ynyl WrelpU,ny D Catriod. . Pruld. nilfl ❑ ... ununmwn . :None Do Otrw i

tic I

45

HDMSe00106387

Vi pipi ng

A AI> ..x :alatl P GI>4. . . . ~' .:: .~GG•r ~:~u,SC . . . . . . •r ~nGe• fO F p

'E UylQeri]rOyr~ p :yny~ a Garay ❑ w Prlv'Lfurl :❑ ~+ Suci,on C .. .p+rnon+

Unrnbwn t Yes Year 04 r•ci:eau'.. . .-

VII Loots D+lrction

❑ vlital ❑ .Stau In'tNory ❑ - Tile D' un ❑ Ylpur SrkU hIC41% ❑ a Srrts4 Milt un-4ew

❑ w uroum wale/ MCOI& p well ❑ , . P'eIWI Ta n

0,~0t W

VIII fiMmlc. Comp" on of Matw1M& Curr .nUy Or MwIous $U p" In Und.rpround Contunwa,• - ..W .. .., .. .. .. rV tO . tw•W~.:(e . IM1d -L6-'v .. .

.rr

ter w w uw '~ .•,~,rc + .~~ . •1 wF .+w 1•ww '••' ^. .. ..uM

~IIIIIII III I I

I

❑ 01 ❑ G.

❑ o,

❑ o.

. .. . .. . ..a t

y a t

Cat

I (III (_I I I_ Iqa+

I I l I I I I 1 I 1 1- L-- _

I IIIIIIIIII I IIlll tl lll lll l

IIII IIIIIIIII ~

1/ Corvalnll •OCAIeC on an Ayjr,cullufalFarm r ❑•- Yei No

W 'NIX IMPOPITANTI Rena inau~cuons tore

S&W i4urr T'1t +rrr nluai C.' i6 gne4 Dy a u. ,nr kw eo .c .l .o *I cv at Iri ~erlel ut +rcr presdrnl c, OY a "' .,,+n ~~_il] .leareft[nl i+ +e Try r*LsewmaIlw

must of itipf)nslar 'ol th Gv erei 30vlal*l Y ,ne tacr. ly ..!`..t IN IoIlr4 4-1 irk ZIciu. c 2r a Mill `wnr* prop,.i& 7r 3j a p-nuprl eGe i Fvt Crllcer

renwq alfCI 3 amc,ar or i„+ndarortaptikiclGI . k ut a C A aaencY

Trks imm nik attn c OmpP.C it Pl iri 0en4y al pi' . y .na to mr htu ,7I my onoew* ;a Ir.a And C 311tt1

.r. . .o tiro. T

lin/ uhtnalle '1azlr3Ous S.Cwnet SID( ap t %&Iwr +r Stain Will' Pllsolaces .,x++, ( Bowa P O BiO IOo Sac, trrwra CA 95YOI 31 D O

u.v~ r .p

CAB 7lJD- S ~~~:

F ddhion.f IOr111t at rnorl ►,dormlt Ofl Wt n4 T24- till

PON STATI uSl ONLY

a

c . .

B4 1L0'7t

HDMSe00106388

ti - - Official Regislrat,on Form, ICMforrrla Wasw NlrrolKCn ConIrol Iprrd . . ~

Hazardous Substance Storage Stote"wnt5 ~

1 tree E Cn on mwln tladbaout ruba4aftr Fln any unOol the IV* writ" are In[JUa00ars CY

~ Q5I .1eMe p

P'r+urCCCOla•riei mull lrtlnlb ram ra laler It-InJuly 1 1984 'Alle, OCluoiw Flea; Fa each Tank IeO .Llerrp r $10 41 "n-p . he P" aucepi l 1w rNNI

1 19FY and n. late, thanJAnWry 1 19e51Jr u.rlks two on larmyl Quicsn mil lions pay f .l pill tent

peWYaoh N Nnderpame Cppaelnera Tnk Id* appiti,& 10 COnL i1e '4W1" Fula llwe to lilt Ihr pafj11y .L $5011- :15.0000 pal ay 11 yuu Iuiwly

sumps non, uAtil turwo links a DIM. u,Sde,900uno CunIL,/ 0th 1Waltl rwamal,nn you Len be br4ro up ro 120000 1w eachovit Ink MYprmaho.n . L

C,wat au-niol . IJ10 ;11 Ali ccr.a rleia inClucYnu kannun waged LMI por .av MUM CI one hlL AOl dean cOrl cICP

Iagcx Mns and SurtipL trial .'[' OHO* the 1101-'S p,Jurld Lurlaic ,e.d nfukl" . it you hevt rrhWmaI Dn F,rolocled t'ly Iradk asCFel Irw-,

r@q%lel A lynb GII n~ on it* Wound 15 r101 Ir>Lluacd Cordaurerra wr lwly VW81i' u1WCh aksl Or the inlolnaLOn on mils loin . Thai IL coNOeryy ono 1n6

b.nLolh the Lue ac1-' •le InL IWEv7 irW0 uI „n11n111 Pia Donds And 1ag00ni; u I1 CAnan Kn GonI'0VnWWlny IIICI ..d1It.; Lp0Cd .C CA&6onfi of howvarll slalu

ale c0 0'YO it eanr no& Deer I noyto lrun the LID uy/ alto, lu [ullLlruclulor yill and Ceyc la w

a

W"'N rrnlAn Mrr 'lo/nu AIUCF all lorm6 Iooofrier Sec./44y . II yOv owl mat: lea nInc lCddy NOhI lSal Qfydlft('1 1, noi CunMaileo [onbli u .. I .DnCltiuw pl uun

MuWpaCol. . hIs. Fal arW 11 on one Icwm and .leave it Wm or, ill -e

beadHoh d hlatarooua fup►lanae Any SutislanCe 1 L1ed sr 5ecl .Jn 6kil 1J

50 . lank, ya, can for .rv o malf on on cornpula, rape Car 9161324 1262 IpT•l' I t : oOuf-IhL, n .31'n eno Seof Inl' lADi, Cube W Ur SfLCLDr, ,L1150 m Kyama110f 1

nck,oeC paadme o .CLel Iuel all nousll .dl LOlvenls Fn LLC OL`s herD-CloaoThai is w01 a FerraM ae : All U q(rJrourlo Tanfif wY be AuD eCrJO

and lumlpdnlatl Ink f1WIVial mull Dt La•l•ed Dy A W4131060 r.auler ar p

ja,LYd ol al a 1`428 rOouh eeaLla WE .S e.(,IOSwe yeI*laltl piFlbure duC to ocarleg eallon Some . urn63.Llpni; have rlreeOy bb gun f$opraml Crwck

with you] "I County p00 errvnknl lot Vim IteglMlW nmum ru9 illot

. .: heel 0 0wcorr4).7a4i 0 n al woo halm nun .ans ci wilW .lo yam

NOTE : ALL U1,4DF11Q11OUND CONTAINFAS MUST 11EQI$TE11 EVEN $ STATE ANDlOII LOCALPERWTS ARE IM FONCIF .

] OwMr . . . .

UC cNJEI .~ ..O&C02P UN- ELSEGUIJtOjI!, v

a•M Arw A U

"12.10 -*ST LMpEQIRL 1.4wl ELSE(LUgO C~►

II F&CRItylrur wm .

R1ti1tL7DJ N E_ IL W .?. CD ST^-Sfew

6633 CAK064 tVt±rr.n

818 710 3OOt.lArfl.'I p l .wa r Rr rkrary Rlyd Areas

. 11o+..Vry

S 1 1~alirM RKS

111 24 Hou[ ErnWgencY Contact Pr

r1 .~ .. . AStL N .-,- rrrrr YVi .MA rrlnrl.

p'p JTEETiv SEIWIGtr.S F1RP. DEPT 8116-114

-V(- A'CA KM4 PA R I

❑ u+ Mofa VafuGa Fuel Shiloh a% Citne l

qdi N..rl . I.V ,AVrw WH~ ..nd h•Wr' • au t"„

tAT I

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

❑ a Sump ❑ vi Lagoon Pita Pond ❑ w Omer

6 Manufacturer (0 approprlalel : .~--- Year of Mi p

D Container C&Paclly/l

F it Container Currently uied7 ❑ o Yet.

C Yea, Ineulled ❑ unknow n

own E Container Reparri ❑ c' None f Unknown ❑ m Yes Year

❑ o Unknowno It No, year of aW use

Q Does the Container Slots (Check One) Gi, Waste qrw Product

Does m Container Store Motor Vencle Fuel or waWl Di? ❑ vl Yes

V Conh.In c Conurwilon

A Trocknres of Primary Conunm(cnl • 13 Gauge thchee C1 cm flown

B ❑ al VaLllled ( Located in an un cierpf ound Vault :) ue Non-vaufed ❑ oa Unknow n

C ❑ u . Doudlt Walled jif. Sengle Waled ❑ w Lilted ❑ a Wripped ❑ a Unknown 0 a None

J11" lit Caioon Steel ❑ a 5tamnlecs Sleet ❑ o Fiberglass Qw Polyvinyl Chloride Cob Concrete ❑ r Alurranum

Slee+ Clad Q N Bronze O u. CompoFle ❑ ka Non • mal1WC ❑ .I Eanrlen Wally

E 13 of RLrober Lined Q m AWyo Lining ❑ .a Epoxy lining ❑ v. Phenalc Lrrrnp

F ❑ '3rcrroeno yylrp p v r yr wiaplan9

❑ ~ Glans Lining

;0Z'%5OZ4 5

Q a Clay Lwbng

HDMSe00106389

VI Piping -2-7 h

A Associated PIpInB Above Ground ❑ . Underground ❑ oVeulle a

B Undefgrourio Piping I Gravity ❑ 1., Prossure 1;0 1 Sucti on ❑ o. Unknown

C Piping Repairs ❑ or Nona Vey Unknown E j, ., , yes . '(eel of mosl recent repair

VII Leak Delletlon

L'),,, Tire 0raln ❑ wVaporSnrll Wells ❑ uu Sensor instrumen t

w Ground Water Monitoring We ll s . Ow Pressure Test ❑ uv Internal inspocoon )dw None

❑ Other .

VIII Chemlcel Compoaltlon of IMatarlela Currently or ProWouefy Stored in UndergroundConWneqI I O U CrWCkud yun ru IV-H yUb afu nut re4uirOd l0 compk iC Ihi4 necllu n

NwW( ar w ...1yGT~Ir SS I0 , N.+ Irv L . xrvr . (,.f Nairn 1414 *nw .•u iwewi w fl 4AAr .

~'- ° 41.1.1 0A6 r iI1 YhwrR1

❑ o .

❑ 0 1

❑ o . ❑ 22

❑ o ,

Dof ❑

pot oa

❑ o1 ❑ _o2_J

❑ ul

1 ll

❑ o . ❑ ~ LI l 1❑ ; . ❑

Is Container healed on an Agricultural farm? ❑ o . Yes fu, N o

IX IIMPORTANTI Read instructions oelore signin g

Npnslura : Tree form must be algns0by 1) a principal execUtivt dl carat Inc level al vice,prasidera dr by an authorized repreaanrall ve The repreeenahve

mull Ue re(ponalbte lot the overall operation or the Iacany wharf the IankiS) are located 0)a general pannei prwiviol . 01 3) a principal executive olhcef .

ranking atec ed orI ci al of authorl:aO repreaentalive or a pudic agenc y

Thy roim has boon eompMloo under the penally 01 penury Arlo in Ihe hoar of my knomedgc . is llue and c or rect

Pried NtimTWI

rand chat t0: Ita :ardouv Substance StorageSutament State Wale' Re60urCeAConlld Board PO BOA 100 . SaGUnenro CA 95801 .0100

For oddlgonal forms or man lntormatlon call BIIW324-1262

FOR STATE USE ONLY

:u~1r q.rc,~ .r~d UIIU d)

ad 34641

HDMSe00106390

• Othcla Reglstratlon Form~

DeOni e4l W UndMerevMf COM01nNR: 11IC Id* aPP&W$ 10 coral relr

r' Wtlleln nl W

SHazardous Substance Staraya Statemen t

M1i MUM Fes . £ acn person-Owing hala10ou l, LuoLlarictM In yny uM6, tl•w 1arr l►Kaeref aIr Inc; ..tO 0 _ .be e.ce Mal Ialax : . . .L1I te WIna yvurlo c anlalrler muff lilt IN, foil r, w Mar n Jv1 I 19Ba

NOW7 IM SfaR as FIRG Dtrf WI.-314 I A S 1

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINE R

U1 1964 and nu eiv, Irian uarlWry I IW5 Ia Wrk. u"O an Iermy l

a' I td C JGumlc3 rtDr,_nOO l,ul'eO ,Ii C. Wrlc' nd.lygl'!u

Il ddLtlh Vr, wi, u P.u PCuoe cccuun 13173) AU ccrlalrerl rIciuolrlV iu n1/900114 0110 Lwr'ps Thal .11 belu . Iht normal pttC no LunaCO 'eve' mull

r$QILNyr A Iank 4II .r,a on the dr t .rlc is nrx ndluoied CootaII H.• rc WnlrlI y

I1 GOn5 . ..d~10bone .lh Ir,c l~lr1114 .I[ InI AL. cl LIEU of urlI (t 1 run PMtlS 0

ale COVelea I e1Ilr. hek Geer ICmCi.t c harm lnr UOtapr . sled IC CWI ILIIttLI

me IloCly N(.ntal j/1olny la r.01 CUnnoi0re0 C0nap J% GOrl ba400 ground : ..

level

Dae11I'eonat hla ttardoul $ostance ' Any LuL .'.am L I lira In Seu'on kaB 2

of the L awn Crxle or In SLcllun 25316 0 1 me ricanrl and Safety Co0a Trrr

ulCludel. P7 YOIIne 0,eflx l .tth all 1llouLlI Ul sGYN rJY Pent r Oen rEtC :Itle L

■no durNgdnIL 11 11( malelA1 must DeCalllOd Oy A IOU llelkO l.aolel 019 .-- : .

pwetlul 1:1 a ri0Zlltlou5 Olasle 111k IS C~p1iL. .e geryerllta prea .ule due IC

11ea1 of dlcOmpollncn of wout o harm human. or wadldu y0 nsL1 .9411 1

1O.

w... II.vO.yt 04.10 . I U . I10 1* 10 .1 Ow ..Inn. xxLaw 1.9

+C111NOrtMa Wrlr R.sourcea Control Board5 28 Q+ R

p11 La. .'1F liii wlf ply $5 Per lan k

alonsi laA F at la,lale to Id! Ille P91tWy IL SSW- $5OOl oar oay It yw lalsdy

. 10 10l,on yuu Can bd nnetl up Ic 5200001w 111Cnyay 1M wdrmalton Is

MCwICCt 11111 he$ nor Won cIMleClutl

Cp4NMaO IIIY: if you hove InlwmotKKT Pldrtled by Vase seClnl IOwl . .. . .

West, elldCh 0 4S1 of the lMOrmyl wl 0411144 form 11101 If Corllroeragl Intl rhi

100 l C]Iwn tot COTLOerela. Iy Including LpeCd .C Cllallo1Ld re0Yarr flalu

IGIy Ono CO$e la w

Hu111pla Contafnera: Fill l and 11 on one tam and lame it 44arlL on all me

lerrau .n~ Corms AIIYCh as IOtet I0 .111101 Let ulldy It you own molt than

50 Yanks you canla0 lnlonrWtiOl oncunlpulw laps Cali 9161324 1261 lot

vllomauunThi is i a hrldt Appiraeen. Au Unoergrat i Tanks will De Surd to

10111 IlxjuillOn Some! IW1LtlICINlns novaaaeady begun progral1IL CrlocM

Kith ytul 1r1C11 COulNy govfHfi *nl 1wJW Iril IrNwnta110 n

NOTE : ALL UNDERGROUND CONTAINERS MUST REGISTER EVEN IF STATE ANDrO11 LOCAL PI 1TE AM IN FORC E. -

r1Pl. capot•.U' 10Lgwa r.aL Ay ty l

¢ALK W .U. Gt l'QR "10 N- EL SC-GUMO~ry . IN

9OECSE&OVDO C A'ZZ 3O GAST LMiTMIAL 1.4W9

1.c T rw .

RLYJtt TzJy N E 53,s

11 Fell

w1

0

IV DeecripNon

B Manuleclwer ( if apprOpfialel. Year 01 Mlg C Year Installed IX unknown

D. Container Capacity \bJ - gallon s

F is Container currently used?

ae lnu P(AlIIe1 l1Cluoer Fee: Fo1 each tar* repls+ir0Oa $1 0

GfJCJ1 T61L, y

CANDC,A hAQX.

Unknown E Container Repa irs 0 or None ' . Unknown ❑ w Yet Year .

YYes Q of No It No year of tool use ❑ w Unknown

Q Does the Conlsln terStore (Chock One) ❑ o, waste lw Product

H Does the Conlolneir Store Motor Vehicle Fuel of Waste Oil? Q u, No II Yes . Check appropriate bon(es).

V Contain r CorlWucUon

A Thickness of Primary Coruainmonl ❑ Gauge ❑ Inches 0 cm- if Unknown

1 : 09, Vouned (LOCa1BO In an urloerglOttt 1 Vault) 11AwJolon vaulted y Unknow n

D. Carbon Steel ❑ w $teirlle >.r Steel ❑ of Flberglai¢ ❑ w Polyvinyl Chloride ❑ v Concret e

C ❑ a DouDle Wallas of Single Wasud ❑ .0 Lined ❑ w Wrapped 0 t Unknown ❑ m None

G as Atumanuill

coo Steel Cwd D o■ BrOnzrr ❑ av Composite ❑ IoNOn - metrWC L] 11 Eannen Waw a

0 it Unknown 0 to Olner

6&13 C 14KD6A- Vt

I1 ..rr1 11 1000 r .r Early

3 7 MK KS

4 5

CA ?t 1104401 . .. ..E

300 ❑ .I Rota Vehicle Fuel Sla t I on 41D 01nat '

HuntVeto IT .n w

Gall:

pllrw .I uI.rII .,Irs,1w ,

MIL IN=?. COSTASr'r.., Quill 10

L-

11I 24 NOur Emergency Contact Person1 r

E C ~t Rubbel Linea

,

❑ w A1kyO Lining ❑ u, Epoxy Lining ❑ w Phenolic Lining ❑ a. Qlast, Lilting O m Clay Lining

❑ JN4CIe0 el a Unknown G ,. Othe r

F ❑ P .,iyelnlentVWriD Q .V nyl WIoOp,l1 ❑ . CalrtUdu Plugf-.LJn wUruulown Os-None ❑ wOThel

HDMSe00106391

A_<~as.7 -h O?a,ny .__ . _.~GG .e ( „stl :ar'Ir 4~7('.7r0~nL ❑ . d.rllO I. 2` "

? urunown ❑ .I Yes Yea, of »cs: +eceru re .ru -

VII 46ak D.4acUon

O . vts.ar ❑ Sta .M In eNory G w Tit 0,im ❑ . veacn 5r01 acws 0,, Sensor - suuT

O or ha r

.uy

VIII Cham►cal Compoaltlon 01 Matst1Ms fwr ► Mrry o hwlous& $lartl in UntMryround Coni norafl,;..ra Ywa .I~1V-r a . :wi4 nOi W.wlutl is anpklc tn :i a .C- I ., .q

w..« .... ,r rr. . . .. .i~C . .. .w • ., r, ...W... . ..~ . ~ n. . . . ... .

❑ o. ❑ xj

n ol___. .

❑ o.

D .w

II III I IIIIII IQn

Dof

Ou .

°° I III II II1111 1

w 11 I II 11 L I I I I I _

if Gown r i oc sietl )r1 an AUI C'wtur .l Farm) yes

IX IMPORTANTI Reatl ,nsltcctions wore %Qn1r19

rdi_ea ~f.7 [feI T`4 Iur mul De o.9r.8O DY ' i y. .fv Hal ex .C,I, .tlJr4ce-t al In! .P~e• .A ~~CE pas.tlinl o Dy i .l .~I

muss Oe respon1Dw 10 TN -flaw ~Pwwu01' N,n! focoo *r.M .t lne fankts, ate hxslaa 21 a }+rwal pal Sf urQpl .IIOI 7r 71 a p 'nCQPrl 6A*C .1 of lilted

I$rrrp Wc)w7 0H.C .L or sumcv .taaspawriat-6 w a auJ C Sgrnc r

TN. . io rn P46 oefn COmp.*l c .+•+a .o lrx peniGy OI pwi✓y nC to ma CM1 JI my kWM*Lgf is true arlo CortiC!

f Tt 'e .lµnl .Ir M ~I~

D .

land *hem w Hataroow SuCtfa + c e Slangs 9uletrr i Sule wales AesawcSO C .xw•c. Bare 00 Gaa 100 SaualmelIO CA 45W1 JI i!

-M 1

M CJA GtS

.v . .w

F .aIi111onM loam w men► Motmabon CAN 11L224- 12S

B LMos puny PGyn-3 Ca iaf ~ .ir __C Frutsde Oar Scl,art 4. . Jr.tiO .w1

Cplc R w+s Q- .Nor .

FOR {TATS U4[ ONLY

HDMSe00106392

Ulicial Regrstratlon For montro OefG ornlr alr~Cw . _i l ~ d r i~>AW W C

Hazardous Substance) Storage Statement % Z f ) K5 5 _ I l k

t) mum F *D ; FaCh per61n 61Olln0 haZal00u16 sUbalantlls In ar'y YnOar

9IoWo C[ J1141Wr mull 146 Mir, l01rn no 1O1011han July 1 hies( Allbr OUl:oel

1 1994 //10 na isille mill,uanlAry I 10141 D, wr*l us60 On Iarrns l

DaNla6el/ M Uri we trawke Genlesmig e: Tile LLw ippb6s 10 Cork reel :sumps n0I, ,.Mad bunrO I1rl . bin,, , an0er01Oun( CJN1lners 1 01(ile r

bpnelllrl like 6W1ac0 ell r-ouzwo L rrwo UI unllnd(616 Pon0s and IdIjt00Pl 9

are Corele0 it 6elln nas beer) IPMO~:l l li)m like stuia 1 11(14 iU OOIIf1111C1

the 11cIly Noon pr dlny lS 001 COnti 401010 COnkIlUCIIOO ber0w ground

Deaearwl of H1Weow {t eIe1O .: Any sutr tame .rLlr0 n SeLo iii 61112

0 Iht Lariul Code or In5ecl-on 20316 . . I the nrbaMli and S4l (yy Cod. Tr .

rlClude l, Qaitotne tl16rI1 lual III Irlousllial 9OIV(1rIIi pel1400C5 nr101Lid13 s1rW 1WIMganl s . I l Inc ma!Fnal n 114 0( "l1,1>0 by i -9-911,160 ra .1 0 dla: .

pu8a0 or s.1 a rlala(CIOU S 01111 UlIe 11 .ItUSlve gerler . ltl pr036iae cue l 0

1 CoOti Yiiciur*13173i All CCnlwtwrllI rclu,ynyLannlrwIIIOCFrll ponds

lagoons ar111 9u1Yp9 [hot 111 b0Uw Inn nc• male 210veld kW11ct *Vol muO

1ag191eW A link SIIIIrrj On Ir* y71ounci i} 1101 Ir .CJ000o C.0ntair*UI (Anlrll y

hdal CV OICOmpOSII .Ot CM w0WO Nall) numin( or WiIdrlI) you mu(.1 Ia91910r . . . .

rile) 1W 111' a1101 We 01(luwd

Felt: F s eacn lank teflNelao 1 SIC Nc rr11A1 ne Fld /)cep trial ,11p14p1lol) - 11(1001 Pay S. par la m

PoraA 601 F br la-lure to hle the pe11111y .1t i il3Q i5 (1(40 Wr day It yuo Ialally

irap r'La rO yuu ran be Iated up 16 $20000 lc QIChWy Ih6 Ir1101mauOn d' . .

nrurIocI and nab 1101 . Ilea cllrreC100

e4pnhaminisilry: II you rt inlo,mahon pioIIct d by bid. 1I061 laws .. .

u iSc All4Cn i Ill Or Ihe Iril0rrr116C'l On finis l(rd~ Ina1 l(1 CON10enbal ar10 IM

uwa,Cal .Crt 101 CONi0enliafly InlluO.fl (p1Clh ( Cltalr011s 01 Ie4CVOIa 1111u

I(ay 1110 cob. W w

YJOpIa CaMMnna Fm 1 and 11 on one loan and IaaveF blank on 111 Ina

llrm1U111ry IOrms 1111Cn ap IO rrA Ioglrlntl sti 't$y II you Own mgt Ira n

50lankv you can lot InlollribIion on curnpul oi rape Cal 916/324 1262 IOrNO1moliun : . .

This. to not a Pwo Wl AppYCWan . All Unoergr0Und Tanks Will 0e SubleCl10

pc1' rlryulauOn Some Il/IO01Cll0ns hovl alira0y deputy programs Cnock .. .

wah your 40(11 CUUrN1 (ovammer I 10, Ilplnel WO1ma11On

NOT): ALL UNOfRcIROUND CONTAINERS MUIT REGI>IT[R EVEN W STATE ANDIOR LOCAL PERMITS A11E IN FORCE.

I Owlwrwlw ICarluwon 10.0 .11 r PflCnywcr I

Qa-V, Wf.u CA&P-0QATI O N- EL S UWDU

I 3a FrkST LM1?LaQ. I IIL 4w2L11 FticIItp

o094 115 71 0

W11r ~wr1.r(ELSEGUU IDD cr► gazas

r1a.rl &-

M4YJ*-E i D- N E0.. ►, r w ;w~r

Mg- W .m STNS... 4 1a1

cr / 'C- r .11 I iP

mikii%rlo as

66(6-63 C ArIJOGA .A Vtn . al . .

rya-Y- A1'C' 11111011 r w coat rp p Ywr1w

Other '14 MOlor Venlcle Fuel Stet on W6❑

rylrpf ~lVrrv . M awr Nwr ArMr. . . . 1~

7 "RKKSM Dl+l r

III 24 Hour Emergency Contact Person

Dort w .1 WW -W, ern PP W • 5u Cvur -- --

FRAWTI. seR.WIGGS FlGE. OfPT iii-314$900 kIn . 1111 I fl rill Mb Pore . Su. cool

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINE R

rv Do"dMIIkM111 . MAIM Ir 1w1• C M IW11wr 4",r IL L

A 'A o- link Q o Sump O . Lagoon Pit or Pond ❑ w O ttwi I BQ

B Manulaclurer (d appropriate) Year 01 Mlp C Year Installed Unknown

D ContainerCapeclty LP-0 gallons Unknown E Coniwlnw Repairs Do None "oa Unknown ❑ no Yee Year

F It Container Currently used? D ill Yes : . : 0 m No 11 No , year 01 tall use m Unknown

Q . ..Does the CPnlelner Store(ChCCk One) . . .0t waste ProduC l

H Does the Conlainei Store Motor VehiCla Fuel or Wast er Oil ?.:: .Aal Yee D W No It Yes, Chec k appropriate tlortlsa 4

Q or Unleode0 ❑ oe Regular Mai Premium o1Diesel O o1 Wsata 011 ❑ o Olney (List )

V Contelnar Camtrucuon

A Thicknes6 of Primary Comainmenl --- 0 Gauge Q Inches ❑ cm Unknow n

B . D of VauMea ( LOCSIOO In an undi e rground Vault) Pike Non-va A00

HDMSe00106393

• vol P1pw>y

A P4S.k4100 " lrny A GG .r ~ ..u .143 Iv1Crl7 0l,nd ZI .avlt0 29 ~

a unow9four.0

c Plprns Fepirli oc Nora .. U rl0 n--- ❑ ~ Y0 1 Ya 01 -CS: Iec I i •ecalr

VII Leak D, .cVon

❑ .- vapu Srdt +vwta 0 . Srn.or r)Sliun n

❑ .d OtnW ..-

VIII CMmlcat Campo.atlon vt MaWs" C arr nlry o Pre rloualr SloeiC In Undrground Containw e;rr.L-Uu YUk .v IV .vr y .a . rw~ . 4-*Q 10 aNC+-'a irs

I l L I I I L I I I I I E~t2 lr

I I I I I I I I ~J 1CIA

dor0

III-IIIIII-II IIlllllllllll l

L1 I IIIII I I I

II'III11III11L_1 11 I 1 1 III L L

❑ M

Oyr 0

❑r I

ulirJY ❑ v PrLK4 .Js X" S Ct1(/n ❑ - JMnown ---

1

If Cortialn.+ Iocalea on an Agr•C ;alutai Farm r G ci yea

IX IMPORTANT Read,nstr,,cuons Detore Win g

muse 00 IehpQlL * 'go ! u ' .i as op.+ .r a• . Yinr iac .V worm the tarok, Ma =A1601 a ~rrvral pannM . L a ,

,ar,..fQ owcl >tli~ay :d auihol, as 'Opt rr.arut, .e uA a C .GM[ aoiencv

Trotlpm '48 Draft con-WW 4rutr IT*waay al pef ry . lC IC If,t)fa1 JI my krID+NJpe Ia NW utl C,rr*C T

/6@r&tw .: T'la Ic- rrluY1 Da &W*u DY a yr,I~C .yr1 .ea.C ~i.•~' oNCt.f ai IMrrwr ,a ~.ce I0( b i ._IN i .e,; learasan4 -'0 11 r raprrssr at,H6 a«d y 3 a pfmcipal A C r1.„a Dlllt w

Ir.r . hrl~.y. . . .rp ~~ .

kfoid a$SSY rs Kau+aoua Sutwarra Storapa S1alart *wr slate Will P A % J rcn CanNa Dora P O D~. 100 Saualrcnlo CA 9510 1=0400

r DOOM" tarns ar I Ofi IrW*rmallwl c .N1 Ill. 324-13 U

FOR hTAT! USE ONL YC V•w

[ . J

Cl

HDMSe00106394

Official Registration Form [C.Mlomla Water ipu s Control Dowd

Hazardous Substance Storage Statement

Wb MO Fran Each parson 4l0rltiQ naZA1000i £uDflanCrs in any U1`4304 - ins LarA WltlalYet .Clowo

ground COnla.nel rlu61 Ias Into 10(m no Well than July 1 1981 {Allrl Oclubel Fao ; Fox 45Cr lank I 4lilad a Stu IH must tit pare •.Lepl fill fill

1 1904 aria nu all Iran JinWry 11995 101 15114 0 Usr0 Un lormb) gati o sla1lons pay 1p 1 Uin k

PdlrMaon to UnMryround ConlaM1mra' T ru 4« api its to Conc r1NC Padaiaii F o, is ore in hi. Ini panan y 6 S500-SS000 Pei oay 11 yuu Will ,n OrOIC lp cnlairwir iwaler kad Ic $20000 ico 00en da Ine rhlormal.On sSUMPS ndnvdulled 0ur (O is N.4 ur 01r1 ueuu "IN l1,i11on vuu can Den Up y

key*] lemkd xr~ L-Hm3 Allaen 0 IL1rmS 10 'Inv1 LrC Ur rlyl9r you own rr,de Ina(

OwNYan all FlatarrOUa aUbasanea Any 6uo61anc.r Kurd in Sr' -,n 6Jr52 50 La- IOU Cm Io 11/1101 1r0YIrbn on cumpulel Iape Cat 5161124 126: for. ..

of the l CcKw J in Sirct,or 25916 0I Ihr HCA4h end Saltily Coat Truly indo mlion

uick.9as oauDlne d.ei0t tuel AN IriO,slo5l sorvrnt :: pesl,r .dey r.0±OupeST4.* 1. not a larrlsll AllpMcaIOA. All Unwi pl OU10 1511ks w1l be 6ubrSCr to

Inc IS Lll.ly NOIrr4Il 7ro3.ro i, nUI C l IOerrd COn611ucl'on beow VoUndY4"p il Conulrwn rip I ana Il on One Or FrK7 soya a wan on an I"

Sit! COvrrwd ,I mrln nab bren [n10ve 1 11Un the 61oia9t a ly lu 001 all u[ Icily i rlp 0510±Idl w,• .• Cenllrlr II ie9urlb ;4 rp n'.IUtleO Lilktl Gr U lKb pi, 0(x106 a (I IOSllI,L. l .un IOi [OnIrOcMWily r(Ic UO•np apIl .liC cocoons d rewrvaro Wil u

Cure 44 ch6( . 131711 All CLrilSirltrr6 . rnCluO hy 1annuri *115 0frI lonOh . nEur0Cl 5(11 hag r" been 0 10 110160

is Qoor1 and sun ps 1"] .Ir 0' INo "('e mat gr

"

rrd LUnaCO Wvrl must c ir[ it you rill U1ICNrrlation pI000Cled by Ira0a sacral S wit

rY(pNw A 111115 l u1 Ine IJIUunO is not (CliOIO Coll a'nLls pan~rny peso ILCn 61a6I D 11*rlloirrlllkOni on IN( Iorn Ilui Is CDNWeni4w rrbC Ina

anZI lufnigIW9 n Ire malrnal mural Dr L.IT,rd Uy s reylslrled riaulei 01 6

p0W0 01 1 1 . 1 nr ;ar00ua wails slle d anpl16 ve (J000ldta3 p1esiule due to ICCI! IriJuIalion Sorts krrl1o.Clrpns have alIea0y begun proQlams Cnoch

rwal of 00COmpo4iIIUn 0 . wU 0a halm humans pr rddldc you mu51 i1.,SIe1 sit. Yc o i0c4iIcounty QOvei nfri 1l 101 tuthel in ointil A

NUTS: ALL UNDCROMOUND CONTAINERS MUST MOISTER Mill IP STATE ANDIOR LOCAL PENMIT& ARUM PO CI.

PiUT5Cr I1l . SERVICES FIRE DEPF 616.3 4 I-i S 1 _~.

11 FailI .o .l,,wrr.

R1YLLTDS N E

VDCY,WF- t-L L6&C'OQP n QN-- EL SEGUIJODa."

22 b GAST LMPt'Q.IAL 1.4W!̀

&b'a3 C+4NO6A-AiV'F

Product

104nrury. 91Mcot• rVl'.p /4~..qr

1 8 71 D OO 0 . Motor Vehicle Foal Station Jr. Otnar

ri .rr !M.! /i Irr .Ftctr . RUINAlaaA Turn,µ,. rrlW irs~.n

7 Ti4KKS own

111 24 Now Emargancy Contact Perro n

Ph6 . M.rrY IWI .Iwrrry SI , .rlfl hGw . .' us. CUa M4' rr . t{91.. I lam Will" r'"4'. . 0" Cos.

COMPLETE THE FOLLOWING ON AS SEPARATE FORM FOR EACH CONTAINVA

11/ DOs~crlptlon

C/r. ... _ _ Curs y . J

4h •50 MY

Qat t~M lY UsC-M . nr r.a .as ...ail' o.t l

A of Tank ❑ oz Sump ❑ C] Lagoon, Pill of Pond ❑ w Other :- : . . AA~ ~.

a Manufacturer (it apprOpllals ) ~-- Year of Mip' C Year Ihil*Ned Unknown

D . Container Capacity ll4m gallons Ca Unknown E Container Repelrs ❑ ui None Unknown ❑ of Yea Ya w

F I . Contain, Currently used ? to Yes ❑ or No it No . year 01 q91 use ❑ m Unknown

0 Doss the Container Store (Check O ne) ❑ o Writs %tii

H Does the ConlatnoPStore Motor Vatvpie Fuel or Waste Oil? IOU . Yes ❑ w Na If Yes. Check appropriate bicWtil

61 Unlesaed ❑ a Regular ❑ m Premium ❑ it Del ❑ m Waste CM ❑ as Orhar ( Llit).

V ConlWNr Canshucson

A ThIckneas 0 4 Primary Con(ainrnen t

B; ❑ o' V 8 U1Nd ( LOcrlea in an unOCigrouno Vault) Non•vrtlled

Cr ❑ of Dbiuele waited* Single WOYeo ❑ ,ii. Linea

c.r M 7 ----- -

ELSEc000V CA 9024

nrr. I u .lwl,s,a••w

"7- W .I. GD.STilr . ..w ~iy. .w

-vr

CAND6A PA 21L

n

Unknown

❑ o.. Wrapped 0 m Unknown O ■ Notre

Cal Sleet 0 r Stairllebi Steel D o Fiberglass ❑ or Pcoyvlnyl Chloride ❑ rs Concrete 0n Aluminum

❑ o, Steel Cud Due Bronze ❑ a Composite 0 is Non- mariallic ❑ . . Earfirten Wells

❑ Ir Unknown 0 1o Other

E D o, Rudner Lined ❑ o., Alkyd Lining ❑ u, Epoxy Lwil

❑ v Unilr*0 'I . Unknown ❑ w alher

F ❑ u F-Loyelnr Widp ❑ .- VnyiWill 0

0 Gauge 0 Inches ❑ c

❑ .. PnonokG Lining 0 115 Guns Larrng pis, Gay Lining

CdlnOdn P1Li1MCl .m unr.is.5wn ❑ , N01W ❑ w O1ner .

HDMSe00106395

vi P"

A ASSOIJIed 7 F^C . . . ____ .4G(. . r "~r" .rld _ ,; v~r0~~x7 __ . ❑ . aWlla

0 , . v,acai ❑ .. 54 i lnvenory Tae Drain C vow ScwI hill! C r Senwr nsilumanf

0 a io,11d W*I*, MCirwlO ( inQ WMa ❑ pr4LrL.r

0 Othw -

i~-IY-n y,x . :pc nU, wr~w Io '%A 'c !w nVlll Ch.mIc Comporttlon of Mat.1 i Curn nUy of PripNtwary $iofs in Underground ConlWnA n

00, III II I I II II I

I I LIIIIIIII IDar

a

0 ❑

Co . ❑

Dar

0 .r 0

0a,

ll lllll l ll l l l

1L 111 1 1111 1 1 1

as Cona.ne uc31Fc Dn in A+yaWrur01 FArnr C :.i yes

IX IMPORTANTI Reid lnelrccl-onsoerare Wing

yd•i r: a

.)mygl Da'&Spansw,r'O4 Irw 0rararl Jprlallc' ;na IaC :My -nart Irv larla{ir arGlyry; Tbii fart" rT1{ryl De LQMtl Di, %, a W,~4 W, tlrac Jl .. rt an.cer iI ITli Mval'A . .C* arsainl 61 DY an .„ Ind ,.w a ."7riSlr4irM I r>,r:rrrre M , na,~v~

a 2 at rwr Vvov wcA Df ]fa M'naWW aiko"i~.f ditlcaa nl I +rwIrI i *Cf$1 0160 + Of iulnd,Iaa rapt acar00l, ft A a c . C i.rllC y

Trni roiM nu pain CDrTIpM &C ,main Ina pm4ir I pwrvry•r,D lo Me Dag al my .no .laupe is owe ano rntlac r

To r

SwM t7ri114 Yac ~+&LrDOua $obsiance Sldapa Smiarnern Siam wau• Rnarcas i xsra Boa•a Y 0 Bw 100 S.cfarr4o c CG 9 k 10100

FOR STATT USE ONLY

c ..

B Ur,O rcur. F•$o GrAwy C . arless rfe +~ IGrl 0 jn .ro «n

-C Piprr . Rj-D"$ 0_ Nora Urwrx)Mn C3- Yes year al ^csr eCSrv 'eWu

V11 Lisa prt ct ort

HDMSe00106396

Official Registration For mC *"orr a *star Riwurces Control Iorro

"a ____ Rea : I:icn P-(", slorln9 "Z610ous subNafCw6 Il any ynotn

91(wrta Conlwdler mull ltw ems 10rrn Xi isiw Ihmn July 1 1904 (Alibi Ock iv

: .. 1 11id. inc no vale, than janwy~r- 1~ ,,1965 Ia Iarlki Used Oil larm61

DsUnleon Of Und.WoiL1L / CN ...W11hi .! The Ia« appkeS to COCLrelb

Sumps nowt Jnea toi .roI an ..L to lAnei 'naer91lond LUnla MRS IWarif

Cede seClbn l31 % 3 AilCOrialnels r,Cfud.ny LJnne• r, walled f+IY pahtl6

ligoons And c r nOS that a,, ariuw the normal 9luur .d LUrlar.C ievwl mu61

rp,S1ei A Iona vlIri 4or : Ine gi ba1d is not .ncluWap CdrrlaaA ls panyll y

■ no lunx(ranis if the nit le1Ul mo,i be La,-0 by a regpoIrled r aulw Ms . . .

plliwo ul or a nhla 'oous w8Llt sae 19 do a0S ve lerteraliri; omss410 due to

NOTE; ALL LMDERGROUMD CONTAINERS MUST It1OtSTE11 EVEM W STATEAIDIOlt LOCAL PERMITS ARE IN P OIICE .

tYC.]c \,J U CA&PO2A" D N -- EL ¶ E UMDOMaw .m...

Cl rt:LsE&uund CA 944WST =NQLEI1lC IM'2Z 3O ~ rIs

II FAC Ntyrobe, w

Iz. Jtt~.T"D .9 N E Fe__

0 Was the Container Slons (Check One) ❑ u Waale

cw..

Gva~LWw « 1

(P 13 CA,9OGA'I4VF ICANOGA PAR.ILegr.r . rasp

❑ yr Molot Ver uB I B 71.0 G, -400 L _ 1

III 24 Now Emergermyr Contact Person

raary Ta,w N eS FYtV . r .At...Tv.nC.i.

, T M(KS OeItr _ _

a, . wr w IYO rw,r Will ra . P..ora DIMS./ru

i'ErCTIV€ Se e-s FIRE DEPT AIL-394

Hazardous Substance Storage Statemen t

berliamr (Fie Sunart ■ ICncluoed LIned oI Un1i11&d µI6pe i2j, and Idquons' . .fire CUveleu Ii bane has [leer, remove from the slola9c alto to COnLnua

Ihi Normal jraplny i ; not LOnlapereu Cor II ucljor below V oi,nd

leve l9 ae111uon of Narar0OW Subi1i110i Any Lu1Llanco tiled inSeer on 6382

01 the Laou, Crave Ar In 5ecl .Ln 25316 31 Ihr rlcaen anti 5alely Coo, T1ew

wlCludes gaLldrne dlebrl i.el ill Inousll,al i.CAYerils pe0IILIOBS nrrplL•ne s

1Wil CY 06compi611on 0+ wai .4 harm nu mans or eJOlae you mush 10915101

11W 111* waalei 1. 0 tnCUae d

teat; For each lark r Llerwc a $10 lea anvil be paid ucepl ttal stall9asollnc alal.ohL pwy 55 p ' Lank

/e*ialtla: ho. 0lWa l0 61r! the penally Is SSW $50000 l nay a yuu a1W1y

r,Ibrnal nn yuu can tx tined up to1200(t0 tar each Ca Ina lnlprmabnn Ii .. . .

mconeci and hh6 r1a1 been LuireClua

CMM1MNWINIy 'r 11 ,0u ha ➢e mJurnal .on piOlmCled by bads Sacral IawS

p aisL allrcn L Mar o1 Ina (Aloe rrwlmCn 00 Ih161orm Ina[ la COrlboenlal anp the

IuitdILJ1 .un 1ol-cbnllOtlrlnaMly . Inclualri apOCdK CililvOru al reievarf tlalu

ray ant caws la w

Itutapta Cant.1 .ea : Fill I and 11 on one lotm and Stave II bl and. on all the

Fernalrany I(Nrn6 Allacn all loam: (09emvI Lei Wary II you owr• more than

50Ianka yOG Can In mill lallon on cumpulai jape Ca li 916/324 . 120. It)(

,N0rdtalon

Thta IL 1101 0 P~ AppYsaaorr. Ail Un0eI,pa,ula Tank& will be ssL.IOCI 10war bi+Jwdr1on Solve lurrsb,cuan0 rave alreeay begun pra9ramL CneC k

with yCW IOChCourtly 90varnrylert lot I ilrt@r Irt1malion

F.(Vil . . r.Mrw . 1111 111 i1 . Ne e .nrIL .r SG. .Ca

ra s e

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

IV Deacrl p

Tank O o2 Sump ❑ o5 Lagoon P11 or Pond ❑

~CA IAD4rw tTIY YET M'RTH~C :Olne ' MFG~•We FUer Station 206

Ca11WLr Mind elk. •• 4 T i .u .wrl iLra^. _

Otrwr

UnknownManulaclufer (d epproprialel Year or Mf g

D . Container Capacity E Container Repairs ❑ of None 41w Unknown D o, Yea Year

mg W_ 'SThs

C . Year Installed :

gallons ❑ Unknow n

F it Conla,nor Gurrenlly IJ6ed" 'tine Yes 0 G2 NO It NO . year w Ili use Doi Unknown

w Produce

Does In* Conlslnw Store Molar Ve hicle Final of Wawle Oil ?

V Contarnr Consbuctla l

A Th*ckne$ s at Primary Contalnmenl 0 Gauge 0 Inches ❑ ci

B . D a, Vauhed (LocaleC In an undergrDUnd vault 1 $LL Non•vauhe o

❑ of Double Walled W Single WiteaC

Unknow n

Unknown

0a] Lined ❑ w Wrapped ❑ . Unknown Q a None

1D.lu v Carbon Steel ❑ w Slalnlesa Sleet ❑ o, Fltteiglass ❑ w Polyvinyl Craw ❑ go CsiAciete ❑ a Aluminum

O or Steel Clad D w &wve ❑ a Composite ❑ is Non •melaMrc C3 , Earthen Wall s

❑ u Epoxy Li inn 0 w Pnenokc Li ni ng 0 v Gus: Li ni ng 0 a Clay Linin g

F Qo FJiyelnlenv Wlip ❑ . VInyl WIappTi 0 .,, Calhadl . PILAecilllnX

.. Uru .rtdwn ❑ . Non, . O W Olhel __.

HDMSe00106397

C Pipnp Fapaab 0 . Clore ❑ Lnkn o

A l xa1s0 Puny AGC.r ar 10

unoNarourn P1019 uri .ay. 0 Pretis „ ra jk~ Sucucn C .. Jnrno« n

C

n

•+C1• :p2ur . . . . . .0

0., r Year as -ca: 'ecw reraar

VII LOA D,Nactbn

❑y SIoC inventory 0 Tae 0,,un 0 . v .pu Sr It 6n1$ 0 . Stnwr -nsuurryn

crrn. .ru. . rvI .t•: IV •Hryur o . c r u4wr uc ro _ .wry.. .. ..r.t stio .u4VIII Chem" Composition of Mat. i. Cun.ntty orPravbutvr $I r*d In I7nd.rpround Cor t nar y

r. 0 I I I D 1 L<G L ~'w~

LI

0J . ❑ al_ 1

M rL

Co .

III I I I III I I

LLLI II I I I I I❑ w 0

00, 0

C.

Da Il l l lllll l l l l

I IIIII II II I

is C,orwains .oCileC On an AyV;CwlurilFi Firm) Oar. vei '.R .: N o

IX IMPORTANTI Rao insiructions Delon sapnrnq

r • .' aMdr 71 In.re.a. ul ..[t ya{ aarn ar Gy an a, .ina. r, .~ . .7r[senl alir. TM r.pr .sanlal.nn< w rc.. y wT'Ii ~. r^ mwr a,e v.pnaa a ~ i~IYLyT .

mt5 ow r .sppn %kD* - 4 !M ~a .r .M opearrGr "rr . iaCury -r•n@ m. :rarx, 1r arr r<w&wc 2 1 a yev.b~ .wrw wap ..ld x 1) a pr-ncipSa ►icwnve on .cer

an" oeciw ancal or aucha rl.a r .pasarl .u .b „1 a pow i. ncy: . . ..

Trri lot m hat Oein comp.4aC ,rr .a.r rrx ownaUy d p lury .nc i0 me b 11 my . ncme . • a uw sno cor .acl

Owrtir-4 1

n .wo .u .r. ... .• . .r_Fn

lrnd uMw /1s , Azxrouw Swo{unce Srarap. Swlu.wr Shale wau+ RnarcesCorrra Bo &a P 0 8. b c Sauamarrw CA 45YOr 3100

IV

SG7 G

Eor Pddran.I 19"M or Mai I orrOAM n aaM I1frf24-131 2

FOR ITATI uti& ONLY

HDMSe00106398

e

Otticial Reg istrar on For m

CaMtornla Walte r Rnnarcee Control So Wd r'

la goons and surnpa 11111 (.- DNnw 11* nc,m.l gruo1rd aurI4Ce ravdl mush ce„HHA.,tsAWly ; 11 you h.v- intamahon protected by node a crel IArrs

re¢sCr A lank e.ll r on ne prouno 15 . not r ilud40 Chilean S partially . p1CAbl li4Lh 4 r51 Or Ihh 1NOlwIalIOnon this Iprrr init IS corkloenwl anu Inabeneath the surlYCL a1C ,Relu3eO Line X urla(rec oi. c dS And l6i)OO 5 yrachcal .:.n for cOnliaerllreOly Inciudin0 11p4cr11L citulkX4 on rele:ahl slalu :

life COvirlrtl l tifln has teen removt~ Iron the slOISpt 4rti IC, cOnallui-l IUI Ya, CA6rW«

the I .L'LlI NOr mat ;Irioiny 5 rr0l COr'SioereO LOn411 tCl,pn below (y DUndMUNO a CenWnWW Fill I And 11 on one torn Arid I*Avt II manl:On as In e

unt aWaal PM. Caen DCCSOr1 alor ro fiuaroous suownchs in on, naoy rree iar* 111,911404, 4.10 nu.KJEO

QrUIMO corila.ner mua111e no lam no into, Iran Slap r -1v1nnr . VLnuru~ P$$ : For each grlr rgaltreo a a1u Me rrl- 1 1 pao eaLep mat r~tari

1 l9aa aha nu laltr than J4nyary I 16 to Lanka uaeO On larmsl Par .nkne atai ina pay , PN (ary

t n ol Uawrera d C011WnMY Tr* Lie apples 10 cOn. rely /yA e, roe li;lve to life the Penalty 1635(di-$1 .000 . pet toay 11 yl.uluidy

►umg nonvoulleo Lw .o ii -$ (Arlo uno.apruuna citrasrwra IWCier Irya r L& l nn yuo un be unetl . it 120 000 it. each des the ND malon i s

-.. . . . Cuoe sod iun 1.3173 All c cn14 neNC ,nCi .b?1r earlhu CalMO pr6 POnd5 rn oriocl and hie not 6eerr cwreclua

rrma.( .N loin? A1l4Ch AN forms 109L'Ihr1 aedulaly If you own Mot tha n

tr,SeariWerl el Hazardous SubMaasse A-ir s,usianc Islip in Seel rin63oi50 IArtks you car . We In1011nalAr on Computer tape CAN 9161124 126 : I0r

01 MW Labor Coue ut n Sdcllgn r70310 1) Inv r1n lr, ono Salssy .000v This Irllp rile. Sv1Ck.deb p.SO( nr aroso tuns all Ir1Ou61r,A SOlvenli. CelhL,oes hcrt L0ea

W All under round TankA w1A oe sua,leCi toA YiOn gh4 rnTel aIOno IUmrpenlS It lrrt mAltnAl mural Ut 1Hr on or 16 re(,PSre14O (1-u hta

2 lo 10CYI rnj . Orb Some rr aJ.CIIOna curve YiresUy begun prOW anla CrncJf e

re tlenell lt it' L4 u0s,vt p e _ p oappuaeO of al a nVorOO .A w4He Sus .18c .. _,.a. ... ..~ ._,,., 11 ,. .11- n . .m r..r.,on . n .a,,illn .-1 musr 1052(1 . with tour IO(.41 .0uruy govMrltrlent lb kather IntOIrr6allon

NoTR: ALL WWr11a11ouNo CONTAINEII{ MUST IIEOl T1[ N EVEN r ITATh AND/O11 LOCAL PlMYS AM IN FORC E

Hazardous Substance Storage Statement s S5 - -

.. .. :nrPV r.wn :10 .-0.81. P- AV-, I

QpC_ W C.U. GD&{'O(Lt cr O N EL SECiUN001wsM Ana .

2L3O C OST =MPCQIAL 44W IC. r

ELSECLVUDO CA 9024 5

11 F .ciMt yiris r.nn. ,

R.CX_rLF r N t S S Sr LrwIwn .n,a.w•re..

M (Z W ~. STAS9 r Mu.ar r

.ww G WsN .r. ~

.. .C3 r✓ °a.Q

_

. . .

YatyaaPaa

£ 3 C APNOG A - 14 VF41 1

CRNDC PAiLILGrw

A ~ I304

8 710 C. 304 ❑ -r Motor Vehicle Fuel Sta ti on a Otner l`1TG r T

• a T«...4, .r. r .u. . tRtarel Arent t,".,.r,,, rww a.nolr

7 /TPN KS Drrr

III 24 Now Ematrg.ney Contact Penorl

I-p1< .oTEcr SMICt3 # i e. DEPT ISIi•314

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

IV D.eclipttonLrrWaer wow , N erw r• t rnl - , d - .akrj+ on. i

A O 1 Tank 0 w Sump ❑ or Lagoon Pit or Pond ❑ w IJtnet 550-

appropliale) Year 01 M1 9~. Menula aul er. .(dC Year Installed . . . . .. . Unknown

D . Container Capacity pallone,. Unknown E Container Repairs D o1 None Oar Unllnown ❑ m Year Year

F Is Container currently used"' ' o Yes 0 ar No It No . year of Lail use' 0 w unknown

a Does the Container Store (Check One) ❑ D, Waste',w Produc t

H . Does the Container Store Motor Vehicle Fuel or waste Oil? 13 of Yes ~w No . . . .. 11 Yep CIMCk appropriate bol(es )

IAI)0

~t

Other ( Il 0W Omi 0 a si .ast eocum ❑ w Diesel❑ or Unlaeded ❑ m Regular ❑ as Pr e

V Contetner Conatruc$on

A Thicknesr, of Primary Containment 0 Gauge ❑ Ir>chn 0 cm Unknown

B, 0 or VeueW (LOCaled In an underground Vault) ❑ ue Non-vaunea Unknown

C O o, [rouble walled I'Ai, Sin(11e Wa it ed ❑ ,, Lined ❑ w Wlappeo ❑ a Unknown L] % Non e

,o Carbon Starer ❑ r. Stemless Slav ❑ o . Flberglarr, ❑ w Polyvinyl Cnlorwe O oa Connate 0 aI Alunnnum

pry Unknown 0,o Othe r

❑ oi Steel Clad ❑ a. Bronze Dar Comporde ❑ 'u Non rnetaIlc 0 ii Earthen Wall s

1 0

E 0 yr Piston Lined ❑ w A14 yd Ling Dui Epooh L1rang 0 . .. Ptlenot.c Lining 0 m Gist Lw" O in Clay Lining

❑ n UnkriiO (,,. Unknown ❑ ,. Olnrr

Putyeinlent Woo ❑ : Vinyl %N?ahu rN ❑ Calhisdn Prute i,an)(

. Uru,nuwr, ❑ r. None ❑ u 01he ,

hry,n . P.fl Ira1 marry- Man arro Pnort w WA La

Z1!1

HDMSe00106399

a

❑ w usotn1O walar Mon,Ialrrp Waft 0 Praisve Tag O . ,ntwnal InsWC1

0 vuua 0 x SIoCK Inosrtlory G Too Z)rarn 0 vooct Sr II teals 0 . Samoa mtuurrarn

C3, . A(na r

'I - cnw,Kep ..raa Ia IY- .+ . Uu m~ nw •O .lWU io . wwl .'~ ~nrr .,n .ir., qVIII CMmk Compoaltlon of M.ti 1 Curranlllr or IrrWWouI ' SWroo in Undsi round Contain c s

CAr

terra, 1: ., \.r .. . .. ~• I '.a -- & .Per .+r.~ ~M . w~!C

III[III11I11I Fu Qoa, Oa I I 1 111 1 1111

11111 LI11Ior 111111IIII U

❑ u, ❑1_-l

a 0

0

I LI II I II II I I

L III II IIIIII I❑ or

O w

a w

❑ a L I__I 11~- I_-I H IIIIIHIIII11I

0' I 1111111 111

❑ r.. Y~! Yeah o,-cii @Ca rd leta a

1of

I 1 III I I I I II I

is Cpr ti alnar ,O si*c oon an AW( ,cwwtat Firm) 0 ~r. yet No

IX IIiIPONTANTI Raaa in5JY CtiOns neiase signin g

/IOANIrn: Tna ,c.r^muI1 Oe G9r* Dy a ynnc t,& eK .c.,( . .r O'¼C ii Irre it.*, .A .+.Le parpttt or by anA .rnO,,_w.: ~lyrierxN~re The raueatrnabw

mull us rtfpanLb*a or IN c~arax Opw aI O4' )I ;1* ac :ary w nwe raw linrvs, are rw1Ifa 2r a pwmar WnwIoW"" r at 31 a p.,ncrpal *-*cut,-* on,cal

rarwrnq wc14.i yl .]ru p Aulno"Zod rip tr Na0I . ~l A > ACY. . ..Tara local naa won cornowlaC jnda , IM penall y d pniury inc 10 IM GeV 4 my knoa4e ,]Qe !i rrus ano c arrec 1

rr tor: .. • • .. :ylr

thwa * Natardwe Substance S o apr.:.Surartwit Slate Wala~ iiai.O,rcas Como dcaro P 0 S.U 100 Sac(arrv

Far adlaWonal Items air nwrs MlorrnhIoh call 91& 334-12912

FOR STAT[ USE ONLY

A £IrX,il0O3L.ny __ . . C. : . . Oc.ra~1O . ..

a unoergrowc Pr

~~cr J rouna

CAfa .Ay 0 petl..'e .. : pc,.r S.rCllpn Jrlrrlo .vn

C Pipnq aaoaws 0 Naar . uni rows

X2 6

VII LaaM De tection

HDMSe00106400

Otticlal Regib1rallon For m

Hazardous Substance Storm Statement $ 3CatltomFa W.1 .r R..ource. Can" ft&a .. • Q A

WYr. WIr FM : Eaten P fOOf stonn0 huaroous suUU .nCrs 16 an) wriapo.- IrIi mill. Ka S4. are rrtCltXjea

DsMrrlaon or UrWwomu M CanyYmet ; 7 nit Id . ■ ppkrt 10 COncrelr Psni aa~ F ar lailwc to liii Irte pfnaky li SSW 3 000 pfl say k you lali .iy . .."Mm rmnr~Uhea Gur,,,o . .-s t,r arrki ulid.i rUOnb LUnlSi'. W! (A'aler it rrwFGn yuu (_an o,e lined.* ie .12(10001a fact a s) the irfurmauon i s

ta6e pro nU tali' than January 1 1W5 ii tJrMS ow on larmsl gay-C stay'W* p.Y 9S Per to,*4uno cixt(a .ryti must log leis l rrn n later Iran JJy 1 Mien (Aunt OCIl .OW Fsa; For fact tars rfQWkte0 a $10 We muff Vat P" OAC*pl lnat rllallr

the lacrl .ll No rr ly ' raOlrly s not cansrpelea clan et uChior belo w Wound Wl►ula ConlldMn : F il l I and 1 1 on one form aIIO k'ave it ataM on all iny . . . .

ale COrrlea ;l term nits iwer rrmore : hum Me blord9 a tit 'Vii-, 0 i1411vi It(is ar10 case La w

Derwatr Ilse SUr"actle indlu Iwo Llrrea (r1 uNuk'tll .li gamin aria IdgWnti lutld.oal.un 101 CaNHIvNraMi iacluOing a(YCitlL CitaltOrl4 01 IeevCN tlalu- . . .

l otappani and sumps era +r aw Coeatanaaky: It you visit Wurrhelion ploleCl" by Irat►t recite lawshiss s(111 A lanr WIIJ y on line pia irt0 Is n01 nCJuCk 0 Conairitrs panlrlly

. pkiasu wil.Ct K621 of me rMarnWlrba on tht► IDrm that it Conlraert,al rrrso Ind

ff IhP naTmal lU FIC LUneCP k1i rtiuil .Ci10e oUCltan 131 73, AlL Conlalnlrri nUu(tiny e anrxn *&Ik U p.10 PUnar incwrtCl a no nos riot [off, uitiecleo

lprms Attach AN l0rrhs Ill~rrl Mir sYC uidly II you Own mOrk thanUa .nr

healar 61DCOnlpo1611 .0n Of wOWO harm nimunn Of ti .lathy yo, must rep( Slor Ypo$eO 01 51 it ha7YrO0uO waslr pit is expus .vt yerwalks pre ssure due to silt.. ..

Ots 10 ~ ,)L ryy gpverrtrrrfrA Or l Mir10f iMphltk0n

tea ]um.Qan4 Jl the rtalrnal mural Gin cYr nea Gy ■ /ryrS1e16 tau W Orslocalretjwallon Sorrie Li►archons have t i eltoy begun pro9rtms CrOCM : : : .

A9Ylck)Oei pasc$.ne a,c$ol luet all i i 0lrlal solvtniL pe S1100" rr lo tf Ttva is tyola Parade Apploaaan. AuUfdprgrojna Tara% rill of sugecl t o

OI the LAW Cole Or in Sectwn 253tb 01 Irti; r,edtn Ana SSarcry coat Tray INbmBIlU11

b tl

yrRptMwlaan Of NaaarOnlrf S"Wleam : Arty suDllj%(, I sled m SeclrJn $3ki%

SO laraii yOuoitn 1%INU l'*li0l on CDtnpulrl tape CAN 916(324 1 28 2 lot

NOT{. ALL UNDERGROUND CONTAINERS MUST R101STER EVRN IF 1TATL AND/OR LOCAL Pee WT$ APA IN POPlCI :

I Ownsr..r .a iCalsoi- wr .ow p i'. : , ymcr r

MOMWEU iUK('o(LP flON-- EL SEci%J JW

~2Z 3O CAST 7-NIM .IAL 14W~i ELSE&U D CA

F.t:.rr W^r

rz=tt-1O.N E. S F L-

II Facility

vv .

.• . ; .

iv . to nyn„D

M - W .I. CD STAB

rrM04A£ G C A► N OG A 114 VF CAND6DIPALK.

env. • rv. Coe .

ale 7 1 o c300rrwn. .. p Trxwx r 1 F- r Plural Areaa

7 Ti4K i(S ~r

E 13 ui A03061 L-1180 ❑ w Atiryd Lining ❑ y, Epoxy Lining ❑ .i. Phonokc Lining Oa Glasi Lrrtvyg ❑ a Clay Lon g

• III 24 Now Em.rpncy Contact P.r.on

Dar . Mar/ IMYn VYi NW trrr - r .. U.S r p u NrTY 1rw r~rrr yu rtl hYrk . rw Corr

-- P.9 T1W& SE.IWIG.S FiQL DEPT 1IL-314 4Z S 1

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

IV D.,Cripbonea.trw Ml n I i t.. r' :w er . .waS. MMtr wY~

A of Tank Cat Sump ❑ o,Lagoon Per or Pond ❑ w Other 1%Q 324 V

e Manuiectufei (it appropriate) Year 01 Mg7 C Yepr lnsitatled Unknown

D . Conlalna Capacity gallons Unknown I E Container RepWs ❑ of None *Yi Unknown ❑ ox Yes Year

F is Container Currently useo1 nl Yes Dao No If No, year 01 last use Qa Unknown

o Does into Container Stoma (Crtack One) ❑ of Wade 4 W PrQducl

H Does Ink Container Store Motor Varrcle Fuel or Waste Oil? Di. Yes Ida No II Yea,Check appropriate 0"") L

❑ a, Urlteaoed Oar Regular ❑ or Prerywm ❑ o. Diesel G o► Waste Of ❑ . QR1ar (List). tiGLd.

V Cantanar

A Thickrwfrs all Primary Containment D Gauge 0 Inches 0 cm Unknow n

E . Q o, Vsupe0(LOCa(eO In en un0Crgfound Vault l Ww Non-veuitO known

C ❑ of Doubts Walled Single WasiO Q LineO ❑ w Wrappea ❑ : Unknown 0a . None

u Carbon Steel .. . Or.. Sia.rmesi Steel ❑ u3 Fiberglilss ❑ U. Polyvinyl Chlorlde ❑ a Concrete as A1 urmnurn

❑ or Slow Cud Q w Bronze ❑ ix. Composite D ioNon- rrwlalltc 0 it Eanhen W811 3

D it Unknown 0 Other

v1a b; d ~✓M k

❑ to Motor Verrcle Fuw Station 1,%r olr a ' M/'G1C ROGCEt^ M 0111 5

Q v Urwnea A- Unknown D Drie r

F ❑ o Pulyelnlarie Wrap QwV yl W,dPP.r l ❑ v Cathode Pr(xe l: .)n Urunuwn ❑ - NDrw Dot Other

HDMSe00106401

336A tSI.acalea p C_ kc'c

Crwc .tlfJ ru b .~4 -r yw +iu ---- mar

nc!'4ropr.a

6r}naergroww P1.r -Gfa,,av ❑ -Pressure 4. S,,CGCAf C ynnno«n

VI1 L4aa Datocuon

0„ vl ar 0 . . SrocK invervorv Trc Dlyn C . vapor Sall +vs,rs a., Srnsw nsuumara

VIII CMntlcal Compoattion of vat.nws Currency or rr@vioo$i hors in Unerrpround Conta► nanaL.u

-_r

21@

I I i I I I I I I I ~--

o• C

I I L1 L1

,a

l I

II I IIII IIIII I

I L IIIIIIIII I

L I III I IIIIII I

C i II I

II[111111ll

Ill llll litlll

I I III I I ~I I I I I

I I III II I I I

$S Corna.ner poar@C z) n an Agnc ,Jrurar FarT'r C ." Yes C>..: 0

IX IMPORTANTI Read inairwcuans 4e'tore slgninq

IM re tI ul+r[4 pr(!Warn pr DV All .~„rnor, .h7 .,e7r t9am]I~v! T ry rowers inlal,rarr 'rC! 0lynaWrF TV IUir^ 'Tha I e ar9na0 Dy ~ .. ~ . yr •nc 4'M rti .G~~ •~ J

rfl l Oa ieipan4dY ~Or :; nr yral aN 7gM .Iwr• )I nt faCwy ..rwra rM ldfl $ ra: rai.aMla 2 .1 & +&~ pi1ACP rJPrMloy Or ii C lflcrprf iricwire Onicar

1 . J Wlrfrtqa*RCISO AIIiC'Ip of au nar,2p rapr d4 Tl&WN A r p ..C AQunCy

Tn 1orm "1aa aeon c0.r IN4.C unOS IM puvay d Pwr ry +na ' r) I" bow .]r my Yno mN,lgeIS Irw Ina C7rra0l

0. .

►w . .row.nr.r r

j WW dMa Sig Iaiarpaya S.ab Ir ca Sraaga Suunr *w SIN. wwr Resnwc.i Ca +ma Boas 0 p Bo. 100 S.Cram +no G %5BQI 0I0 0

i5 62181 700 Z6

Fair ad4t1Onal 1onrp aw nW.f imurwkstion oak 1011111. 124- Ina

FOR STATE USA ONL Y

Ca, ❑o

C ..

C . .

HDMSe00106402

Official Registration Form 0- '. - - C Iorntr Wuiw Resources Control Baird

Hazardous Substance Storage Stt temant IJ R55-- 34cwINMWO Pis; Each person shin ha2hpoaus su oalancub in why undti awr Ian .. Aairas 610 incA toad

orYb aonlrln.i m. 11 lie Inp Idm o late, than July 1 1%. IAIInr OC ILOel e.; Far WYCn lank I piled ■ $ 10 lat rniM 4e paaq .'cep. Iha ralaa1 1¢64 arttl no Wiles than lkn,Jry I 1985 1Or IarAG WW On ICrmGl eaadne wllO A poy $ t 1.1*

WM11Yon of UnearyrwtMM Cpl n.rI: 1ntl. ippl' 0 conCreit PsfMM. F or lriluc to 1w ine pinilry is 15 $XI f5 .00Q pet coy it yw Ilwl ysumps Ito, . .lied hurltrtl I .rwf c ulrrr indergluuno i .unli.ntrs IWaIsI wJornwl .on you can bd Wed Lip Ic. 120000 for aacIi day the .IOOrmwbon i s

: . . .. : : (;Ude wnron l Il 73, All conragl .rrj< ndudrrjf tannvri wall-- pub ponQk i1XUrIvCI li ra nak nq oeen CUrrrCiyTliOoono antlcunipO lnal dsp be1Uw the . ncvmal Qruurrd bunacc Ie wt mull Caw M

lle[ 11 0 . n.~c Inlurnyl.nn protected/5y U idt ll&Crol hiltrogiller A 'anK Irlbn, Orr Ins JI0 rt0 IG n01 enCloOed Conliult ri pars ily ' y

' r1rrnn.M ItxmIrlp 'la cOnlAeM)n Ir1rll.tn rLSI of ther10ma1ppIi y utlelrtli7 r.on.r .lh V .t furl cu .tE n j .3#o L,nea or unir,L•C pl OUnaj and id(l"i

F

ryaldrCAlu,n Iar COMrdanwuy : lnCluorn0iplrc,JrC t4aU0rli d7akvari il)luLI0 %cl ■lea iu LUninuC lvu r o if karln has teer remorr'^ Iron, Int.It cOa , r0Iy And Caw Ili*

Ihe I.Ltil No r rl,al,raprny 6 riot CunuroereJ consluclior. 0.10* Vo,.ndMWYpw Camlaleen : Fix I and ll on or* term and Wive a plank on au IleICmarr Llh IOrMi AIIPCh W Ipmy Io .rIr1yr YuC Wily If yW 6wn 17101C Ma n

D@%~ er Hlilicl/rl M {V/qa Any Gun sla(I~r ',Sled err r~e .l . :~ 63K

ares Lot Cone w in Se1uan 2b31:6 Of irk "W` and Sarnly Cod.. Trr. 00tirwe you car) foe InlOrnyllron V Computer tape Cci 91613244 1261 lot

d

1CIudet 0y}oline drebtll I,ei a1 inOuSlhal GGdvt[nH. pepl,cides nernic,ioeo iMOnid4un. 11 NOh All Ihoer IOUrVl Tank s sill pe LU[rCL1 10A aCaFT Y +F Qn a N n0 a a

end toIM(t.nlo 11 the rrwlerrlll rrruGI of Carr .td ay a mirGleiid r aulty Orb ..

0 of hi a ny}ulOOUi wawa Will itixptui,vc verlerd186 p/c Giese duC' 10 l0Cal IL idilOn Some uritorcironihove .Heady begun ptoprams Crrt1C M

In - h, .mint n-dill ,, vr,a muss Bessie ( With your Io il CUUriy 00varmN0N tOr7lime, Intolnlalron

I Ow

Wrw Amw r

- I 30 1ri14ST LMPLa 2IRL 1.EW y

NOTI cLL UNDIh611OUNO CONTAINERS MUST 11t6IST[II [YI[N IF ITAT!ANO/O11LOCAL PL11il AM IN FORCL.

rwnW'1 Cntn rc/ i. lObeS' t. Y.4rY, Ayer, I

ROLK JLU. GO&('OR•AQIDN- EL SK VA100IL.,

I IIi i

EISEGt1IJDO C . 9024 5

II Fact tIyrK.MrMUrw

171L1tF-TD. N E.. S 3F

pArir` .I sh AW ..r ra+. -- -

ML. W :?. COSTkSrwW C

I/ l%ro

--I.. Ames.£3 C A N O6 A • *. V F

~., ~. .CANM&-PA QX. A

►EV . F •N G10S 1'~ d Yrnl4ir

'I 71 vG 3.00 M❑ t Motor VahtCls Fuel station ~'1r otnerfiELL& 1f.OGKET M B

wre *rka r .r !AC. . r`~ _~

KKSAura Alaaa

O'pIr

To.r .r.., try . . aio.on

III 24 How Emergency Contact Person

rgaarECTI SERI/ ICESFIQE. DFPr 1L•A14

COMPLETE THE FOLLOWING ON ASEPARATE FORM FOR EACH CONTAINER

IV DICrIPYO(►- a>r~r r . w.u n rn r. wn.r A lilt

Alm Tank ❑ Sump ❑ ci La0o0n Fit or Pond CJ w Other S S F/,r

B Manulactorw ell appropriate) Year of Mlp C Year lit 1aNed Unknow n

D, Container Capacity parsons Unknown E Container Repaid ❑ or None q w Unknown ❑ co Yee Year

F is Container corruptly used? rr Yes ❑ a Nu It No. year or last use d ti Unknown

o Does the Container Store (Check One) ❑ of Waste w Product

14 Does the Container Store Mdw VihiClaFuel or Waste 0II7 I1 Yes OIL No . . .: II YS ., Check appropriate boxiles):

D or Unleaded ❑ e Repulel Q W Premium ' ,w Diesel 0 of Waste Oil ❑ of Other (Lit)

V Conllonrr CanMrucYOn

A Thtcknnti of Primary Conlalnmm nl ❑ GeugN 0 Inches ❑ cm t},Unknown

❑ or Steer Card ❑ s Bronze Q is Compoone ❑ ill Non meWiC ❑ n EannenWal 9

0 to Unknown ❑

E C) v, Rubber Lined D v AWyo 1-11-11119 C) w Epoxy L MV 13 . PhenWiC Lining ❑ ~. Wallis .twig O n Gay LnInfl ----

F ❑ a Poryetnlerit Wrap ❑ Vinyl WIspp,ru ❑ . . CWIh 10r, PI WW.J ill

HDMSe00106403

A-A$ ..XIla a~,r>G- . . .. . C:: ~cc .r •~t.na__ . . r ~~we~j•ouco .aY~rt a

B Urlo* ouro P awry ura . ay ❑ PretiI~re u SuCl .W1 u+rnc.rn

C a,poN Ffrpa .s ❑ < None UnMnoan C . ; v,.1 verr of

OnD

i.ureTYsi ❑ .i . INNneI Inr aea .an : 11w Nov o

VIII Cltdmtc~t Cofnporlftlon of MUt~ 1 . Curr*r17y or Prrrlouafy 31Drrq m Und. gIound Cont ainw a

U -- CrwnxvC ras a. .IC +u . .eu w 18 '4 ;rss rn: ;

Co.

vrauar CTS>51oo . Inc+niory C . T.ei 'am C . VE M Sn,ll iNw45 7 . Sunwr M%ourr,#rr

II UI

' H H IIIIIII I

LIII11 1 11 1 11 1

IIIII II II I I

Of,

IIIIII1111 IIII _I_ 11 I I _I I I I I -

I I I I I I I I I H I I

Illllltlllll l

All

L I IIIIIIIII ICar

in Corw*.n. ocsieC D1 an AgriC4fau4a Farm> Gm, yes No

IX IMPOIITANT1 Read rnsrruclronS Delore Wing

IOW TV Ipr^ muYl Dr !Wgnti Dr a u-c L.* 9 . .CJI- 4m 7l Int Itrar ul . .C6 peWcon, o< P. an a .II 0. thl I i(Vrx.ir:H TIW riUfsa"WiWO

mums D I•Ol) 1Il i. a TPi -il XC .al .oI ~1,na IaCwy . .nr .e rnd Will a.s IOCai.A 2 3 a,jJ-.*I l {rennn proy .a4G OI 3) a y. nclpra A C .IUrt OfhCM . ..

(wav

p EalG1M7W I I

S aeM CDI aYil,aril~D avaalr:lfll~ .6 YI a ArAC a]IenC y

Trills iormPi olla:,e.

pmpelea x-ow irr prnady y pwnay inc.IO 11W Oeer at my KI16Mt7(ta d Ir .e ern CJrraCl

Swe.r.

IIU +w.1f.

0. r

$Snd Wail g ^lu a•arwa SW$JInCI Saorlpl Suru+ww 5+ere *am Rasarces C.x,Ira Baru P p Do- 100 Sav a

Fa ►c Ls

45a0 x0100

o -z6

For ldd O W for"M or MOM Warr iskm OM 1114 7 11U

FOR STAT! u S& ONLY

HDMSe00106404

Official Registration For mCaUlorli WOW Raaoluna ConUW Loud

Hazardous Substance Storage statfinent

b@r1E6lr , Ir,y, Sour( ale'rCluoeo L ;r d r, raRWo (rl6 ofnOS a ia("n6

are COvel oo if f, llh hab Deer removed lrun Ihe $t0lage fled l0 fOUSIIULi

Ihtr 151,1.1y NUI oI . ; 'ntllrv, i^ 'rOr CunSroeled Conl1,,ICUor, 0 flow Wound

hid-imOeen111on C4 Harardau► {~ ► laeea: . Any su0lUnct listed I1, Seca.tn 67137

01 Irw Label Cox La a, Sec11 LG ::x316 jI Ina H(,-per, ana Salcly Code Tra p

IICIUOe► (1ab01,ne O,CSe1 Iuei all noIA lf,al Sof Cnl } peuIrL,tleS 1 11 LldrJy

are lurnrp/nlt if lit rrialelial muel Dr Lair ld Dr a re(1161eI6o I, hal 014

posed UI all a r1NJd 00u6 waste Me IS /k ;400 V6 yleneraleL prE'6b uwe J e 1 1)

heal of d6compoSUOn 01 woWO firm Humana Of W,IIla1L' yo.l meal 1e9 .tilur

ttw Orr Waalfi ale IfCIWetl

Poo- Fa escn lank leplalrrea ■ st0 We m.gl be Pali &seep, het 1 e4 Wpil(,rrb& IOIIrlla PIY 95 Par Liar*

Pewialp: Fly 11 iiU .O10 Iile the penally Ls 15W-t . uou psi jay II yu. 1ANS-Iy . . .

. . .' arpaLnn you Coro 0.l lined W 10 .120000 14 01Cn tl1y IIM Irllormil.On Iii

fOtirl.,Cl &r10 . ha6 11D1 beer, c(yreclud

Canaderw..Iy: II you nave uaoimai onprolaclea by Osbe ICC'(n laws

plwaN, allat) p list 01 the InrdhylllOn an this IOrn' lhil IS Cbnlltlenta and lft

)ulW Lh6Un 101 CUnflOrnl.dIly ntlwing aprC .nL CltalorLL CO relevant alaiu

t(yy ar1a Cabe h a

Mullple Canfaleers: Fill I and 11 un Onelo m and leave it blare, on as me

' .rrmaanrry 10rmg AIIaCM aA forma IdyL9hr, bf( July II Vold Oaf, 1MYii Inan

So afar .you cart I" 1140 1 111111011 on CUmpule, Iape Call 9161721 . 1262 Ii

NO maoon

Vii s nor a Pormlt Applaaiien Air0nOnpr0UfdTank$ wua feaufreCI 10

IUCia1nA}ulaliOn Soww lunuoicil0n6 have ■ aeady begun p10911116 ChOCk .. . .

w.ln your IoCalCuvlly govirnRM10 to (harrier intoirnallOii

NOTE . ALL UNDERGROUND CONTAINEREMUST RRp1$TER EVEN IF STATE AND/OR LOCAL PERMITS ARK IN POIICE :

IZOLKWEU L6k('0RAQI0 N- EL SE-GVVWso" A IU

2L'rb CAST LNPLQ.IRL I- WlLl i

ELSE&OUDDM

CA1 N

9024 5

II F.clllty_

r rrr r.amr

1ZJ3LMF-TDJ N tw

- rwam.nr W.p .r.alr

M 1G W . U . W.TA.S1.1.x1 GIw. Wr.M .

Aoddimid

At,

dd~ .0

U.&V AM wib ~o i 3 C aNDG A A Vt~ C).PWC141'A2.YL Lr=A 110 4

rwrw . .wrm.

8t® 710 G30DI+V°-iii%id F .." Rwat Are .e

yow.Uy,

IT K K5,

p .µ M ..r taut Harr WMrr,a en r.. • .y Door N,p,1. IUIr.. .1. ..1 ra .,r. .11 .rIn .Hlra w rw.(YA

PQ9TECTII& SRrIIGSFIRLDErlllA•31A ZS I

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

IV WscrlpDon

Tank O x Sump 0 to Lagoon Pit or Pond O w Othe r

B Manufacturer ( d app1oprraia)

tart p ` Iyy~r

Our motor Vehicle Fuel Station Fb1 OlhaftjCGTer~1 AA1 -.M0~~$

Year 01 Ml g

D Container Capacity 1 2 .Q V gallon$ 0 Unknown E ConlalriM Repairs 0

F 11 Container currency USad' ' r Yet D of No It No . year 01 last use

Oar+M~. Air . . a nr s w . .afar £Yr elk,

Unknown ❑ ow Yea Year

❑ w Unknow n

0 Does thr Container Storm (Check One) O o, Waa10 "a Produc t

H DOea the Container Store Motor Verucle Fuel of Waste Oil?

o, Unleaded Cl

V Contaln.r CaminrctIon

A Thickness of Primary Coruainmbnl ❑ Gauge ❑ inches ci cm Nunknow n

S . O o• Vauheo ( LOCal0O in anunOerground Vaunt AeNon-vaiduliela Unknown

C. 0 o, Double Walled Vm Sangte Watrd ❑ a Lined ❑ a Wrapped Ole Unknown ❑ lad Non e

D. )ia, Carbon Sleet ❑ a St»Irllel6 Sleet ❑ oa Fiberglass ❑ w Polyvinyl CNalOe ❑ a. Cnncieie ❑ a Aturnin„ m

❑ a1 Sleet Cud Q w Bronze ❑ 0 Compolae Duo Non rnetealC ❑ i . Lafirlden Weld s

c rr Unknown ❑ ) Other

E ❑ dd , Rubber Lined ❑ i.r Alkya Lining ❑ o, Epoxy Lining LIw Prlonolic Lining O w Glass Lining O a Gay Lining

❑ w Unlined Unknown C a Olnll r

F Oii P1Iyelr, lene Wiao Du Vinyl ov app,n g

Wads OW Falls ; EaCh prrsuh UlDrin g 11/1110006 SubSIOnCa6 In and yntlof

pl uuna conl/ul I, mull We in-6 form r1(, Ialel Iran July 1 190A IAIIir OClubei

1 1964 ano nu 11rr Iry ►R J ► nuary l 19510 laflk6 u610 On aarmb l

yY" N Uldergrewlli Coni i*q. Tnt Uw apOlllo 10 00ncrelasumps rbrrruullla Cur-tO 111151.U OlhSu Underpliiono Cunljr'hl S (Welef

Cud& beclitr, 131 73 All CDnlS,nnrO ifClu1nu tunft r w ►aed yll Portal

11000n1 Ana lwrps that •n. UfI * In, rKVrnal pluurld lurl1CC I",1 mubl

. . . ._/1101 A lank irll.r . O( uric gl0tino is nor InCluolD COhllrld'I$ parlyll y

III 24 Hour Em.rp.ncy Contact P4nal

❑ Cornodl. PI(Hn.i,on

C . Year Inulltad_

204 2, 5S F .-

_.. UrudNwn ❑ , r: Nor1.F . . . . . . ❑ w Other

HDMSe00106405

E Unc rgrotrto Pw^J ' a , bra ay ❑ . rrer,s +i 5„C1 ,rn ❑ r wonC, n

C PIDa F(rpa.i 0„ f*oc.. Unknown ❑ . . vas Year or -acs: !eC* ' •eGa a

VII LOA D9400"

❑ , va,.a+ ❑ - 5toca ln ..trwcry ❑ Tao gain vaptX SO, rud+la 00 5401`11or insrrurnarw

Q to urcflrd Water Mcolor,rtq Wes ❑ , Preswre Test ❑ .w Irnwnat rnapacuon

❑ , . Jthrr

VIII Chemical Cnn~poartfon o1 Matsa1 Corr nvy or Pr.rbualy Ilortw In Undsrpround Conta nrl:rvs o ,nan.q .wr4w .,ureo r0r WIV . .. ..:. n Jr~ wCMn:WD rD~ ~ r

r ' ~cl I¢ade Cl

I II111 1 11 1 1❑ a, __ ❑ n

I

~] or

I III IIIIII I

I I I I IIIIII I I❑ ar IIar

_ _ _

❑ .' IIII I IIII ii i

Is Corwarer scaled Dm an Ayrcwtural Farm1 C Yes

IX IMPORTANT) Reed to&trccuonS oetore srq arrg

wryWrrr: . 1 b. IDrr. : mWI a rrpnra . Dr a w,nc V•r e ..~.~1 •r on~cr al U i 0a , .A .w.. pas0Cern a by +r+ ._tnorr.ra .iapreuMat .. a Trw rewasrn,ahoo.

mufr Of r.spnnlu br"dInu c. Ma. ODar a1KK N •ne I .c:, V -"a tom , an,416r arb tOCarxo 2 a .~rrMr Y' p.hfTN tr"p.d x 71 ap rCrp+ l .■i[ .r,o4 unCCfr

raf" ar_twD Oriw,ar Or aJLhOiLiO I .piewrlar,r. A a uDOC aVrrlC y

Trra ram naa been compatetl urop ire pinaay d P+rM' +na 1 0 ma Oaar a rn .nowreag. it I" ann urea

t..

Mrrr ayla.ar * Mazh'do .l SuCSV.nCS Stotapa sta(F'TM 'ra Slat. Witr Ri$JWC .o CON' o Bow

wrrnN r w ttiaw.rr. r

MI c~A e( ~(A c

rot a"16011 49 Iosntir or nwn laranna1on cM I1L224-1212

FOR STATE USE ONLYC rrr

pew,,. .* . .*0 ^t C

0 lieu tOO Sacr.manI CA 95eor 3100

oo -'S7z6_

F

HDMSe00106406

Official Registration For m,". C.I bin . Wawa n.aowps Conao+ WO ..a

Hazardous Substance Storage Statement R 5 s 3 (o 4-

Who M" P : Each pereui ttlorlnp hararaOus 5uDStancul in ant elect

bend conlaaler muff Ia11 is lion, no Yelul I(l r, Juoy 1 1964 (Anal OClt+pn r

i 19A4 and nD 15151 thOn "nwry 1 1965 1pr rynksu5N0 0n Ilrms r

CuO* si4UIOYi .1173) AllCoraydwrh ncludlr,N ca rlnt.n walled pith poltls Incuri@Cl and pis not Ute ri CW'ntautl

Dui son W Uneery uusd C.nI s n . 101 yw apt *B is cOncreit pmaeMS: Foe l luC Id IieIrs penalty r !500-15 000 per day It you littly

ryorfrlauon Ia'lnr l r aCB0 0W 0 15 lF e Iba ykls I i e bled up lb $20Sumps nOnrnuyutl oULrtl mores uI LAW indurprtiunn cunli . ,rya m151,on yuu an Dc

Ia044rl$ Arlo humps Ihsi ti 7MOy Ile nOln,tl QRJUOO LI.51IICe k:rul (loll

re(rslw A ;ant i4I rI~ or1 Ito Qlouno r5 nut ncluato CorllIaWf$ parlwily

bonS .Ilh Ire 9uniCI, it intluOPO L «'O (II oOl !tea [>. 16 Deride And X(1DO15

are coypi ±i it Ie Nrtn has been rt0Ovt ^ lion, InW sib age• Arta 1c cU .%jroC t

In.. I.Caay Normal ~r..ably 5 r101 CO'(i .OCICU c U,,y,IJU . .U uVNn yuu .w .I W I .t... on alp lnCa ,n o1 1

❑ Motor Vehi cle Fuat Stolen p k olhsr

a1Gk.d5s aytdlr>e 1lCSw lu0i All It 0u ca, Lwvenrc pt&IIL OCS rlerbwoa05Thee I. wet ■ /F5rrw11 AppYarYno An underg tlund Tarn s oil be aw„ect t

o olyand Iur t11nF r s .81St

6Sil t

lle 15 Atli dd

vE by

r reylyl el 06 .st 5 f, Clutl 10 IOCaI I0 ul5h0n SOW

IUnsO.Clwns 0515 aaUldy begun pIOQtSm6 Cnoc F

1C1 p1 t•Spo54•.O C oI f r ii l a n~ «as s uI s OMa tot IIlItlhI .r110tnlal47nla win: your l I "bide ve1lnMur Y y 0fl

il &torci n

rwaloF AyCOr<L . Pun I), woultl norm humans 0r r wddlrla ,O~ most regsl

vOn one orm a dFil 1 andMultistate U0fl4 ur5 :Iavil

:. .DuU*l eon at F{atArdou* SuMlerwa : Ar, suthtancv ISItO In Sect Ian 638 2

NOTe : ALL UNDERGROUND COIITAINH1aMUST RI1OlAT1T11 LVLN IF ITATI AND/OR LOCAL PERMITS ARE IM PORCE

.Iyyr ICONIw.u[ . PO.10.5 Ii 1 .~ . A .rl11:

gOU(W F-LL C.O&(O2ATI O N- F -L S EC:%VV DP

B." AdPnIC .,

2x. 10 FAST .M 1AL W.W? ELSEGUUOD

II r .cultyF", rwr.

M0r- F-T'D- N tPaso l clueitr,A r

rA/ l C.

I

r~LA-? c~ 1 GcZ`~7`..I r a"MAN

01 Ina L5bur Coos or n Section -2S3 1 t of 1n 1 hessli I ono SalCly Cosa Tilib

hwu r err. ca w

10 710 f 3.00r .w•+ a 1 arwt 0 in, F-04 Rlael AIMS. . . l1a.r++w

III 24 Now Errwgwtay Contest Perron

'7 "PAKS eery:

Ina La rk ARP" A' IF +k.rw a

Pre : Fog earn taro, rermisr*C a $10155 rr11 Gu pno "COP Met r1W

9SWYni, LLOWM pay ! pat tree

C V$hdbf UMllr: II you rtryu Iruulmahon IXolaclld by tr ade 50crtl 15 + .5

plumSU .tt.lcn aFS1 01 Ihe ill 1101l10non Old Idrm VLSI 7 toNOenW1 rna tM . . .

lUSla-Al .un IOr C0N ornl,iW tn01.101np ipecdre C4a00ns (4 545ranl alalu

Ireu h.M r .C. La w

rem5rrxrly tome Al15Ch AM tOrmo ICIQIIryrl st>tu1aiy II you Own mpi IoWn

50 Iarwa you 055 ISi In1Orrl 6 11O 11 On corrlpulel LA PS Call 916/324 1262 I W

Irid nla10(1

W., kr- 11..1 rwril rVI 5na Pram . OW C100

'zas iCOMPLETE THE FO LL OWING ON A SEPARATE FORM FOR EACH CONTAINE R

d,t Si rr115.1 own ryi 5505!

p- --CO.

QAW- IM SeRWICLS FI13L DEPT 411.3'14 •

IV Dawrto

Tank ❑ m Sump ❑ mLop0On Pit OF Pond ❑ w Olhei

B : Manuticturer (d appropriate) Year of M10

D a None

Deb Conctat e

gallon$ ❑ Unknown E Container Repairs 0 st ,

F is Container Currantly 1,1660? ❑ m Yei w No It No, year 01 LW use ❑ a1 Unknown

0 Doer the Container Store (Cnectl One) ❑ D- Waste Pfoiclixi

N Does the Container Slots Motor Vehlcls Fuel or Waste 0117 D ., YeaV

. No II Yes . Check spproptlale box(sa )

.2 atim,"L:

V COnS6111 r GOMD11Ctl4ri

16111,169-313 CPft OGA - AVF- UNDG PA9.ILA II. O4-

D Container Capacit y

A Trockrreas of Primary Containment 0 Gauge ❑ inches 0 cm

CO-Wow lS .rvII e.nr.n w rw+e .r rWl ar t

ti,O.toD W S S iS

C Yealllulalled. vUnkn0wn

nown

B. ❑ P, Viullad (LoC.Ied in ■n underground Vault ,tr\w Non• farlteo , i Umnow n

C ❑ PI Double Wilted 0 w Sin gee Wa lled 0 v3 Uneo 13 w Wrapped9"1",

Unknown

Carbon Steel C& Stainless Steel ❑ r i Flberplassa 0 w Polyvylyl Chtdrioe

❑ In Yea Year

Do• Aluminum

0 a, Slog Clad 3 v Bronze O w Compneda 0 111 Nonmetabc ❑ IF Eontlrh Wilt

w.: rn

LJnxno wf l

F ❑ Potyttnlrrit W aD : . . .. 3- Vinyl WiaUNv1g .. .

jI

co, I go 4 5

tl.w. I yi+rrynrl.Slliii .

.ME- W .U. CO.STAS :

HDMSe00106407

A Afl. C3IOd p,ny [' .:. :~16G .c ar :~'1tl1

.,suer ~rO~rG . d .Nll p

li ~rwr~rour~ PunQ> ~ ir~wy O . kessde S.rcron ❑ ,. aronc ..n

C Pipn% gpa o Q . woo . . unkna.. n ❑ , Yus year o "+cc rec .nr •e;-a u

VII Lack D+t ctbon

❑ ., r~azry C -'Stow Ino*n101`Y G .~ ToeJ. .rn ❑ . . rape Snit ov um 's ❑ ,+. Srntwr wns 't.,rrwn

Clo. I0IC Warty Mgrmorx>q WM$ ❑ P esswe s •

C Ot he r

VIII Ch*WACAW Co. PO IO + 01 Maur1rh Cur►anMY or rrwlouI y fwraa W Under ound Conta n`r$. rc - •.. rrw .i~~q . .

tr .uu rvw IV -rt LA, r uuwrW ,a vr~,{

OIW

Cur ❑ ~I~IIIIIIIII I❑ M

C o,

I LLllll l lll l

Co. ❑~ 1 .1 1 :1 Il_IIl1L1

11 I I l I LL

❑ o1

L

f Corwarnm ,ocsio6c on an AW; .itural Fa(m) G ❑r Yes NO

IX IYMCATANT1 Aaad nawtccu0na WI-le WAng

Me, oo , Tow lc.r mo. t r .e rd9rrrC oy - a v,nc yai . ..c : .i .v 31#,cr ai th . 4•t+ .I .cr pes.arnr a or * •-~nx,:dil tpre .trM], .+e The r .vesem .i.v.

m .Al o.r .ypOn0o,e 'olIN gnaw 7(r .. ei,W . r ;no IrC .ey wntlr. Me 4 1114 16 i il0,oCSI+ ) A Vdn.IYI pwrn.1 p.I o .a,0ra Il a prurc,pW .tICdlo once,

arrnQ 0*CHW 41,C A Cl aUInoteo r.pr.l drl0U . o ,A t a.ws•c .. rncr . . . : . .

Trvs moor, rlm Dean comp,p.o arrow rht ptn .di d pwu.'•na iC eif tmu my ■nomeayt .A nue AM carr .m

tiros'.'. .Tr

So" dl.ca W WLr0Gu. SuCpance Srwagi SL.tow wit 5l. . War r N .f7WC.I wrOru, 9owo P Q Bum 100 S.c ar. .rru CA 25M, 0100

e

❑ o.

Far fddYo.o Worm air mar. In1ar a on cal $14724-1161

FOR $TATE Uff ONLY

HDMSe00106408

Registration Form4 'dCaNtorn a Water Ne ourle+e Control Oaar a

Hazardous Substance Storage Statement toy 55 - 37

Mil PO Ea ch person slyd,ng halardCU0 SuQal anal in an, urlap i nir lank waS1ea lilt' inCliOedvfiprcgnr cunlaNrl. muff Ilia Ih,y Dim nU laiei Ind,, July 1 1964 (Alto OCIUDEi ha : fa each La rk r601LIkr1A k S10 1N In~J1I be pM0 PaCa~ll lhal ralad

I 1964 aria no yltrl Ivan Jan uary I T98S l i irks .r U on I.,nr i paaoknU stations pky i, PrlLan k

Dslnluon IW Urreerpauaa Con4Mmrr Trio law appdrs ID C0111 warmn 1ir(sampt, 4OnvdJglrO Lined ldr1.L (A W1kl Un(JeFVJ') 0 L J

CJ0nr SOCIIO1 31 73 All onla rwco incluO.nv YJnnLI wedeO pith porldo

ndDenaalh 1111 OWIaCL d L r, :'uO] Q L nw•d Or UOhi W'O rrlt, pOndii ddQUCN1f

art CCi0 I .i7 .1 earl„ hat, oe ' rarn0Ve~ 1,,,r, Ine olOrili ilea IL COnSbil l

Iapdono aril Lumps real rr, DOli,r. lilt normal QWlr'0 LudICC kewk riluw

. . .1490e A ank all r~ anIr•e IJ1OufO it, nor nc1Ldlo COnlaudrrs pallOll y

ttw lar ilrly vornlal OracLny Is rip. conirroererConOhoCirOr beloC ( rIbulid

ldVil

f9eVAMIkM pl M.Iareoua matinee A n y sUOSI anCI liplha in SlCCl on 6382Dr Ilse LAW Co,e 0 in r%Cuon 25316 of the i•Icall n and Saltily CODo Tra ovlciud0b ga6Olne diesel'wQI all,ndcslr,al3Olvenll peSlrcideh lit bll•Ide$

and luml(Janls 11 Int nialer .aI mule De Can oO Dy 11 ra1JiSleIea cartel 04,

pUarQ 01 at d haia'OUaS waste 000 15 CKplUS VC Jer*r Il65 prt'ikWt d .e 10

rural (A OecOmpbIillpn Or WOUId harm nun,drlr Or W ."tv you m .51 Ivq'sI H

MOTE

patlaa S For 1&1,00 lb 111!Ilw penalty It, 15WU $50010 per day 11 you lalwlyifYOllryl On your Lan De tined up to $20 000 1pr Dien dt) (l.a r rayon Ik

ihCUrIeCI one 1110 nOl peen CWItCIb d

C_IIMaahaa111r; 11 you flare WilLurlal'Un pr IICle0 by .ride "Clot laws

pwj,,l, allr(f k kar 0l11* IniQrrlWLOn OnIMO IOrn` Thal Is COnl .Oryayl 0110 the

: . µiudwal,un TOT COnhCWr0 .A1Ay I u.duiI opac to Cdaaixn 01 ralavan Slillu

101y dnD Cal Ia w

M. 0911 Coniafnf 't. F ill I and 11 on one form and 1elwi I Marl on all th e

relTlallanpI(rims Allaen af lOrnla ID~Illlprr Ldculdy If you Own RiCNt Tha n

50 .18-4 y6. . Can Ida inlorniauon On Corhpular tape Cab 9161324 1262 Icx

Inla nwpl n

This in of afrrar1 ill AppllCaaen . All UrlduprbWlC Tank% wi ll Des kI tOCl 10

lpcar IOJwdhIU fl SUMP lUnhd .CIUnS IWol -0oeally tiagun programs Chock

*Ah your 10011 CUUnly goVerniflent Or lprlner irauimaliOn

ALL UNDERGROUND CONTAINERS MUST REGISTER Evil F STATE AM/OR LOCAL PER MITS AM W PO11CE:

I OwnorI'll d0rw10a' I1,.gw u• P,rpd(

I eCX WC-U cJ &t'02A'n0N- EL SEciUUDOIdW 60Ww 1

'2 2.3 b EAST LM PGEII4L LEW `! ELSECiLJUOD CA 9071 5

11 Failidol r.r. .

iZ JtLTD!! N iwea t

/.aprlll

if. 3 C 41406A INV

- .I,y .drlr~ : s.dMnr,W

W . :1. C.0:ST+ S

cn

c.,- .

I•rlw Gull Wrp

CANDG4 'Ae-k . ICA PI IA04-nrdld . old.- a -

I H 71 0 G 3,00 pal Moior Vehicle Fuel Station Qrrv QIhK

:: : : . rr u<tr a rl w rrur, Rwail AtlasTowrhy wyr idea.

MKK5.

111 24 Hour Emergency Contact tenon

a." Wind l.a a Iron am ll -r,ru cv r w" rw,L lyre rrwa rut we Pmru - ii Loft

paxecrive SEIWIf.CsMQ DEPT AIIL-314 4 t33 1

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

IV OrecripU s'

Tank ❑ w Sump ❑ 0 Lagoon Pit or Pond ❑ w Omer

B Manufaclutar (if appropnale) Year DI Mlg C Ysaf lnstalied . . . .. . WUnkrtown

D . Container Capacll gallons Urtkrwwn E Cdntalne Repairs D o . Non e

Dieu. ❑ m Wash Oa $Lw Oilier (Llat)

Yea r

1 is COnl insif currently used? 0II Yes ❑ w No If No, year of 1011 use Unknow n

G Does Inv Container Store (Check One) ❑ of Wa ste `l J Produc t

fr Does the Contarner Store Motor Vehicle Fuel or Waste 01? ❑ 1. Yes 11. No If Yes. Chaco app WLSIa hordes )

Regular ❑ al Premium

A Th .Ckneso Ol Primary Containment ❑ Gauge : .' ❑ Inches O cm Unknow n

B [ o, VaWled(LOcaled in an underground VaLI )--- X w NOmvauaed Unknow n

C D o, Double WSW Single Wealyd 0 ;a Lined ❑ o. Wrapped ❑ ilt Unknown ❑ w None

of Carbon Steel ❑ a Sairl W 66 Sivel Coo Fiberglass ❑w Polyvinyl CNalda Jai Conclele 0as Alurrwni r n

E ❑ ur RuDoerurted 0o AIkyO Llrang ❑ ,, Epo,ry Linin g

❑ , urlkrsa Unknown ❑ - Othe

❑ ., Puiyelhlertt Wide 0 . Vinyl Wrap). rig

Unknown ❑ m Ye s

❑ w Glauo Lining Q u Gay Lining

❑ Cdln;,dl, Pr[Awi .. Urlkrwwn 0 -Noll: ❑ w Omer

HDMSe00106409

A7 - AOL.e Ld K:e'9fDur4 ❑ + d Wld:

B Unoergrour-0 Perry ,p`uld .dy ❑ . Fross.4e ofa' S.ctrrn ,- x-nc

°-WC Plea c Ralp .+S 0 • NO(4 Xx Ur rown ❑ 1, Yell yaar Of ~nCC I&Cenl *C r

VII L6M D0,10CO e

[

D . to MV Watw Mcn kcxo 1 WOOS 0 p ,eas+:+ . Test 0 Irnanal In6DeC$Or1 IIw Non e

O w plnar ----~-

VIII Ch.mlcrl CompwNlan of IA tw1W Curnnt/y of previously horse to Underground Conteurtirris

nior intiIWrdrM❑ .. StocA inverrory ❑ .~ Tao in O,. Vaaar Sou ryalls u . S

qrw ..nrtwU ..llJ . tV - n uu a~~ :.'wl . uuwnf0 ro- w,rfh ac ,ns . .nr...q .

YAM CM

~Y: w~ .vw .--•~~r[ .. 4Jti ~Wr .Mrwr .wa~ .v n~u•~ull

Oo ,

❑ ol

a .-U ii i

II ll1_ I I I I I I

I l lllllll l l l lIII I II I II III I

III I IIIIII I

is Gontslnw .OCare, in an AyrtCWtursl Farm) Cuui Yes

IX IYMOhTANT Rena i nhIr alone Detore Win g

C~i W OPrC - 01 tM ~lyd .CO Ipryyc6rn Of OYIn y-,lnpli_ d4 IaarQ Mnlal :ve Try1 .,eClr . KnlaLran w t' l f .myyl oa Fq,>r!0 Dr W,

; 7 .4 lryr p:mull O. r .3OOr1I& f Of TP (ivw .rl ]gndIK)4' 7r Ivy IYCJ Iy .Afire 11* IarWar artl lOam*0 21 a3eO 4dI prn(W propr Nra al 3t a pnrlc .prl 0A.CuI t anlcar

irr FANClt7 3IIiCJ1 co a .cr10vlo o rap Y7. lr t0i wi : ul A Q%Q c ] gl`r y

Tres warm Nu e.ln ccTplw.C . naw rrr P&naMy d pwrry .nC, !0 . m . . t. . v my vw«wupe ' I r,u. .rq=mar 1

Men . tirl.1.r nrw *,Mo .-V~/ ..

Ziww ON" trc «luaroow S„CUanca Slorags slal.frc v Simi. Wafer A.aancn ,.Yx,a Bowo P 0 B o 10D S.cramerrc CA 93801 310 0

e

vMyr

00 S 7Z 6,

For Mddlyorud lornw or nNn wgrm.Mvn caM i1L fl4-1

FOII •TArn us& ONLY

~ I I I I I I I I I I I I f~ eL n . '

IIIL I IIII I II I1 1 J--11LL1

Q

HDMSe00106410

Official Regislratlon For mCMnornl . W.Mc R*.owa. Contra Soerd

Hazardous Substance Storage Statement

Wl eheal01 doCOmput I ,✓l 04 wOtOO 11111n nun .ank of r.olOu c you . mow rygiLlM wqh your local : County Oerrmer

eyLUrepOWd Gt DI 0 t 41Otll oo u5 wash sot a e .ploO vh y)H nH oat h p N(M maNOftno lal I

rltwOet gawbne dre521 luel an InduW1 LI 0Lu1 1115 pesi .C1d01 rterolcldasThYM YIOI a rerrrYl APP AI Unolygoound Taws wA De au[,fecrlo

AnD lurlijjllnls f hit male rlel mubl Do, c.ar eD Dya IeoJltlleiod 41104 c p15 /~ ~~~ .,doo to IOCa1 IUgwdhOn 50410 lw0.0110 0 naN WI@a0y tidgu^ proQlantt 41 ICO

l

1 DD tDs.rhYan W Haiar+ew eu.aasanC. Any 6oDFI2f1Ce 1-filed in CjaClroll 6]a2 Io

or nII

r 50 un.a you can Irr Inicon-hllcn on Computer tape Call 5161320 .1262 loo

of IF-t- Laour yddt W in rueChdn 25316 W Ihr NuDlin and S0101y COClu Thos WD/maiKin

C . a

Ill calk the o uric Ir ri o ri eo L1re`o orir pus

i o

tec 'IeIrY)uNtlrCdIlOr lot CDnhpi. llDtily IrlOlu01119 IipeCrot Gllaaonl of rlpevarrl flalu

We oveiedlif earlr na} Deer rlm0veo for, ire 9101 .3 . ilea 1C C01lfIrucllay and Cabt'1ID •

me locally Normal graoin, 5 nor Cc.rwceie0 Cunh(ruC110n below ground

Itv0M/Iyple Contalnere . Fill 1 anti 11 on one loo m and leers if clan on so I"

Ch 111 Idm1 Iopelrler WIC 001y 11 you Own molt IfWn1 Im AIII

MOTE A" UNDERGROUND COMTMNEAI MUTT RIQt$T[A Mot W ITATC AMD/OM LOCAL PERMIT. AAI IN FQMC!

I Ownerrvrw 1r.P' I~rol . ro.o,. r. 0a . •wnc l l

QOLKWJ .U- C~II I'O(tPT DIJ- ELSEGL? Jt710w.. AaP+. .

-42-10 ,AST LNPUQIAL I4VW S

II FeclYt yrn a,. Mara.

R.LYJte TDJN Et7 , ,

cm /tYMV Am.,

ilea 3 C+4NbcS a VFi C/ KD( PARa.Plea r woo LIM

L P 0 710 3OOkd tray µ xr r .LMr .

71T`PklllKS►

gr ,v a .legoolt 050 FUmpS net all ueUr hf' nOna Ceirobasorrolmilw : II y Du hYvt r11Wly1alon pdKled by [took- mclel laws

On Ire grbJna 16 riot rCluo4D C.omau urr5 F,Dnlallypiee .u alln . .h a 1111 01 the Inlorvliliun Or VIA lour that is CONU tnl. J, ar10 IMlaglYlvi A l rw immi

t evt~ n,~Fll lp ul cCoon WCIGr: 13173 .i Au 6Olaners inClDlrh tanntr#alk0 µ1s pp+id5 InILUI cCl 010 hIF npl Dean CClr1IClU0M41 QS no1' .aar1eo Lined ln01 Of QlroV unotrgrouna Curui,,nors I Water llyprrraLnr, yyou Can DC IIn80 uo 10 520000 lot eaCrl pay lilt rrormati on i t

~.~ ~

OaWkso" Of Uneergrolrse C.M&lI .

r

.. The 1rw apPYrt 10 COnCrela Pe ee: Fir Iwt a 16 hie IMr peralty It 3500 SS.000 pie Clay It you INW yB5 for wlnkc U900 on1ry 9 armal pso Dion uM~ont pay S .. pp Lot*198+ aria no aft, lnDn 1fnw

..pruun0 conlainal ml.w to*In.& form no lCihi Iran Dul y t 19aa IAIwr Ocluwn Pee; Fa each la0* re?IIhitp a $10 lee rnuN w pro eaDepl vial refit..lr

M MUM P.e - E .cn pwwn florin, rlaial OOO3 suetlar~CY6 n any under ere Orr *WNaa re rlGiaaa: :

1 Wr a eu.rw.

❑ n Motor verNCie Fuel Station 2tt Other

Cµ lumELSE&OUfD CA

Dnr' .1101•rl W r ,f W rn a w

III 24 Hour Emergency ContatlPerwr l

0071 l- I- rwny .0i sO Nre.. - . .. COW

f"Q TEcr s. S t= d Ces FIR1C DePr & ifi-Ao9aMV,,, ft n 11.V ramr• 1r .I anJ PI%fl . .ia . cur.

COMPLETE THE FOLLOWING ON A SEP ARATE FORM FOR EACH CONTAINER

IV Oseaiptlan fourpwr ..r r.r.r 1. uwvpnu r4AMr }Fr~pa, 1

A ❑ oT Tank ❑ w Su

Steel Ciotti

Manulaciurar In approorlale) , __.. - Year 01 Ml g

D Comainer Capecty/k6 - gallons 0 Unknown

M T- W .U. CO STI1.5

C. Year Inslaaecl .

Container Repairs ❑ n ND0e Unknown ❑ m Y

F is Comaxnel Currenlly used? CI D, Y05 j07 No It No year of last u6e

, .

9OZ4 5

. U

year

0

G Does the Cont ainer Store ( Check One) /11 WiWD ❑ w PrOduC l

Does true CONelner Store Moles Ver.cte Fuel or Weal6 DIl? ❑ u, Yes

❑ u, Unlesclo ❑

❑ ,r Unknown

V Con[Nt»r Con*uctlon

A Thickness ol Primary Contammonl ❑ Gauge iltnches ❑ cm ❑ Unknown

B ❑ o, vaulted ( LociIEO In ■ n unaergrounc vault ) - Non-vaulted ❑ o., Unknow n

C D at Doutot Walled Pf01 Singe Wala d D t Lined ❑ w Wrapped

0 0 ul Garcon 51aei 0 o Sra1Ne0o Steel Coo Fiberglass 0 it. Pdyrtnyl Ch1oeDo

Lagoon Pit or Pond ❑ w O1het

Il Ye6 : Check app ir oprule 130x(11)'

Regular ❑ W Premium ❑ w DIeFSr O m Waste Oil ❑ a Outer (LlII

p 11 Ome r

❑ w Alkyd Lining ❑ .u Epoxy Lirwng ❑ w Pri nokc Lining ❑ ar Glaris Living ❑ aY Gay Li ning

UNinec : . . ❑ Unknown ❑ .. Otne l

F C . Pooyrtruene wljp ❑: :. v,ir i WP■ pp ny . . . . O~ Cwrioorl Prul ion C L11 1t 1lOwr None C 1. 0 1-1er

HDMSe00106411

r I A Associated Piping.. . . .. . Q c, Above Ground ❑ a. Underground D Q Vaulted

B unoergrouno Piping D o C avily C), .. Prrssur e

C Piping Repairs ❑ , None ❑ o . Unknown

❑ o, Suct .on ❑ w Unknown

❑ o, Yes Year of most recent repair _ :

VII Leak Detectio n

Vlsu&r Qu: Stock Inventory ❑ , , Tile D ain Q m Vapor Snitl Welts D oSensor Instrumen t

0 w Ground Water Monitoring Wells ❑ , l Pressure Test ❑ r. Internal Inspection Aw None

❑ a Oilie r

VIII Chemical Compollllon of Malarials Currantlr or Prntrloualy Stored in Underground ConlalnmI f

--ftYw u O

U,

y s o rYOU cn ce .i

. . ala 0 .0 OAS Y I I

C WASM d,, N u., 4 :W„rr., . 1 ...,I NJn~- lu o ni,nu,ui I..W~ :w, n,pv rW1Y

f.44mrwell/1/7 ~f+r/~/r~r ft'ST►~i4 Fri'

pm ❑ m

Our ❑ o.

❑ of O w

❑ or ❑ 0o

QA, O w

0 l,' 13 w

Do, Duo

(Du, ❑ w

Is Container lowed an an AgrloullurarFarrir7 ❑ -1Yes

IX IMPORTANTI Read InyGOduona before signing

e reprele rY/S na ural: Tna loom ritual oe srQneC py I i d pnncippl evoculivy dLCtlr: al the level 01 voce prn6rdenl or Dy an aJinorred representative

muss ae rel.ponsihle for the croaraq operar On li the Iscllily wr4,p the lpnlcrs) arekrculed 2)'. Verre,uIpartner prophetof; or 3) a principal executive dlicw,

soaring etaCled othcal of aulnoriued rapleuuntative of a public 119014

This lo m hills been completed rCider the pfiNtry of palryry and . 10 the be'&I of my knowledge 11 true and Correct

liveT h

O. k

hwrt r4m. Tau

land ch.OMf0: Hazardous SuDerenre Slaraga 9wemenr Stare WaterH )ao ces GoOrul Beard P O Boa 100 Sacrarr,ruo; CA 95601 .0100

P..Wn FYrp 6rr .m..wI

. . .. . .. . .. . .. . .. . . .. . .. . .. . .. . .

rr,.,,w . . cuu~

r 7 5' "y 2 E

For addltlonal lonnrw move Information call 9I&324-1262

FOR STATE USE ONLYto WrrY>.rr

ur. w,a ..a

iaa4NWi4. i

u~,

Q-ry h,nYr .

c ui

64 31W

JiuJri o rupuUUS 10 Yarn{ BC IIli6 606101IV H UId e t

HDMSe00106412

Official Registration For mCaYlornla wehr Rosowcn Control soars

Hazardous Substance Storage Statemen t

Viii M+wl Fall . Ea(:, ci r .on slowing najalaoul suoa0r.rr6 In Any uiJOr Ill WM Waves a10A1U.a0AC

ale COvOIrO A Bann net peer ramOre0 Ilun Inv dordot AlearIO COIIOIIu O

tnrucaly Noirrul Orad,rU now cornldCl00 ClnelruCllor) D iowpluundMvat

D&KnNIon of F4arreu. IubalArwa Any 5upslance I fled riSeClyrun~b3e2

or irk- Lel?l Coot o r) SaCIlor. . tJ16 01 Ir.~ rlralln And Sal(•ly r 1N

,rlCluoa$ {Ws0Lne d.esel luel all Inou04 l bl aurvy'nls pelllCr0C0 ntrblr:ldoy

ano lunli lil0r119 It Ilse nlolerrit rnu .r be c aIItea by a regillered flaJlal al .

poled UT ill Oi 14 r0oue wash We isir1HOSw( yhnrlilrs FrrrfiWe duC t o

. . .• Mal W oecomposropn 01 Woul0 nann nurron. a WUdtnd you must re 9l6i0,

wmpti rlonru0Cd t ..lrea . [01* 1 pIntr JnOeIpl lJnd CUnfAnurs I*01C- f

1 ItidA ar.d fie lair, Irian JbnWly 1 1985 for lanwO V%00 on lbrrn b j

Dasrmlon at Lr4MN w ie C4o"narr Tne Ia+. eppllfrd 10 conclele

110SAi0 coml. ner mu,( irk Ih .6 IOrm rio laler Irian July I 1 4 (Allrr Ocloopr Fee! F or wrn !Anil ragI v ewo I Stu lot rrcWv be paid air ltil t1W rH1a

I OwnerPen. .Cooa ..r Iro.na. O fJaL 0 11 ti t

IZpC c W E.I..L c 5&(5oQc,q 1D N- E L SEG V JO--,,bars

(iVULDELSE2230 CAST LMPLeIAL LFW I

II FacHlty -

1 .111 10 .

IiM 21 •~-----

CA 071 5

RlLiL i DJNE.. S5FL M L W .7. STAS

roeyl dam

❑ rllMotor Vehicle Fuel Station ' Oinel

urrw •anF1.

£ C.13 C I4NaG A ~ vFr• .a . Irw LOOP

BID 710 3►00Vi a ,. Tana n I,- Farr Illianel Amo s

0." k- WN, iiirv pi-to

~pj'TE. flVE 'SNWI(rL P FIQL DEPT at&-a 4

C Container Repairs ❑ of None J w Unkno

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

IV DeecriplIM t'~u a

A ❑ o Toni( ❑ o : Sump /os Lagoon Pit or Pond ❑ w otne l

B Manufaclurer (0 approprlale) Year of M10 C Year Installed Unknown

D Container Cepacn4lo gallons ❑ Unknown

F. Is Container curranaly uaea'

pasollneslal.Ons pay I . par Lank

eil"IeL' For I1luuC lb lilt IN peryrlyr0 .I ,Oii-f5 .000 Pa' slay 11 you Ia IWI

.swine! (M you can br IInio c IC $20000 fix sacn day Irk i*prmaion to

InCooo cl Yid IIM Act been COrIrcrp o

Crarrlw.rlhaaly If you 1A . r InrlumOUDn tpOlICleO by bade aacier IIWs

yf0al1 *lI (ll i Oil .r IhE INO1mal .iin On Mt6 torn . 1ry1 IF CONloerlhar no IN

0iII.i cAlron . Or connocrwralny InCluClInp specific CAawans of reterarl II0IU'

l ot y Ano GSe Iw w

MINYpa C onla.ars: Fill Iand 11 an one IOrm anc 1@0 .0 n blank w aw In(

rarnaa vr~ forms AlloCn as !Wins loguxhel beCurely 11 you own more Irvin

5(, an* , you Can I" .nwln`4oor. on cumpufar I541ACall 916/ 3 21 1262 1u

011 V d1Alion

This W not a P.e.elt AppaCWon . Ali Underground Tanks will oe auLl scl 10

local rygu.alor Some lunb3rcllons rw50 rlleOdybogunpr0graml Crock

won y(10' "I [uunly govarnmenlfor lurlher irutrlrrlluorl

wlr*1 IF..rM.lusl rr. •.MO, :Ill Prrwo . . PIN CWP .

'tart`

Yea r

o : . .II No, year of last use 4r. Unknown

G Doss ina WldalnIr ~rore(Check One) JI u, Woato 0* Produc t

Does the Conloinhr Store Motor VerkCle Foal of Wave 0119 0e Yea

O Unieaoed 12 m Regular ❑ w Pr mium O o. Diesel 0

V COnt diner Conahuctlo n

A Thrckne$t of Primary Containment AL- 0 Gauge

D of Vilified (LOCaIeO in arn unoergiound VauIT )

Inches ❑ cm 0 Unknow n

NOn•vauiea . ❑ of unknOw n

C D 0I Double Walled #fa Single Wa ited ❑ i Lined ❑ w Wrapped ❑ u. Unknown Q IL None

0 ❑ u Carport Slaal ❑ o Stairwecc Steel ❑ 0* P .bergiaaS 0 w P ol yvinylChlotioe too Concrete ❑ I . AWrtwrwm

Dot Suer CIAO Da Bronoe 0 Compoane ❑ ioNon-meII lc ❑ II Earlnen Walls

❑ u Unknown ❑ ,o OIher

E ❑ rm Rui0ner Lined Ow Alwyd Lining D o Epoxy Lining ❑ . PtWnolrc Lining . . . ❑ a. Gums LwwtQ ❑ ak City Llinin g

uNlneo Q o Urwnown ❑ oOtnt r

C . Nayalrlrne Wisp ❑ a Vtr-yi W,aupng ❑ . cameo!, Proloc11„n 0 unwlluwri Nonc 0 .O11 r ~:. Apt

POTF ALL U14OEROR000IQ COWTMwERI MUSY REGISTER MN IF ITATI A0,10/OR LOCAL PERWTI AM IN PORCI-

7!g .4"'1 Ax

7TRKKS O1+r.T Wlrrrw

il .

III 24 Hour Emarpency Contact Pe rso n

Code $ecl .Gr, 13173, All Cnlorreil rkCI ;ON rannrn wAlwfd (1110 p011(10

Isgoonl ano Sul1',p] mil err pe1(1w Inc normal a luund .. un. .:( IAYrk n ...dr

reQprt A I000e.Ln ij onlrlt (IICUno if, nor .nCluded C0nierrirrs Fyrrwl .y

: . . , bo nLjr .h IrI L.MIaCC art ,nLlg0l3 LIr1(J Or unw,-c 10111 ponds 0110 NQUOn6

HDMSe00106413

VI Piping - 3 b

A Associalea Piping ❑ L Above Ground

Bi Underground Plprnp ❑ i;i Gravir y

C Piping Repairs

❑ u .Undergrouna 0 i VaultedNail-

❑ Pr6S9uiC Q Suction 17 . Unknown

❑ w . Unknown ❑ w Yes Year OI most recant repair . . . . . .

V11 Leak Defection

Visual L3 u : Stock Inventgry C , Tile Drain 0 Vapor Snill Walls ❑ .Sensor Instrument

❑ w Ground Water Mon itoring Wells 0,,+ Pressure Test ❑ nit Internal lnspecGUn Jdr None

D Olhu r

VIII Chemical Composition at Material" Curranlly or Previously Stored in Underground Containersuqui ' -•N you WCII ou Chucked 11k 10 I

_ owr. .wr <M.w.~ .wOtr ..,KS U. . N, u .. Lum ar, , .i rr .,n ra.~ .uMld .b riw ;: .w ucM . ,n.'

A2T l✓i'.Hics7~~a a

X~v

❑ 01 ❑ 0:

❑ 0 . ❑ 0:. .. . . . . .

❑ w . ❑ oo

6 1

0 0, 002

13 o . ❑ Oi

Do . ❑a

❑ o O w

❑ or ❑ 02

15 Container located on an Agricultural Farm? DYes ]/': N o

IX IMPORTANT" Read Inaqucuons beldre signing

1

alpnalure : The loin moor be si gned oy 1 I a principal ewecuGve o1l .cer at the lave' 01 v.ce-prellaenl or oy an aulrro42Ed repreaarrtalive The rep, .rilahve

must Of respone.bte 1of the Overall nperahan or Ihe i cillly wnere Ina tahwlsl are localed 21a general pa rt ner propr9loi . or 31 a pllnclpil ew4CUIre doter

IanhrnqSlecled ol11001 1 or ■ ulhdrlietl reps eserltaliveol a pudic agcncy

This torn has been completed unlit the penalty or penury aria to the best Ol my Knowleoge .5 lion and cdaeu

t:pnr.wa

hv ..a rwrrwTIe P,. .y .r M .. Qg,

tend check Is ; K"hronus Subslanse Storage Statemerll Slate Water Reriou.Ces Control board P D Box 100, Sacramento CA 95601.•0100

t 6r m,~x,pro

r

r

For ado Uorlal forma or more Inlormagon 1I 918/324.126 2

FOR STATE USE ONLYAl . I.uii r~ .y roll MO M

oeiii h.rv ..a L)

64 3/

l :ulnyllli INS 0uu1unnut r r n luV

HDMSe00106414

r r art: Official Registration Formyp

Wif DDeneolr Inv bur0 .CT a,e • 16 Cl 0 ,r+ta LN unu . . 9 Iuwla ,cIIron IL. CON,OrrNiakly ,rlrJdding sp*CTDC elaaOrli DI r1WVIr1 ilalu

1 ./ Covered if early naS oieer Ie0OVb 0 1i cn, Ina 6io,a c Arta fir COiikIl .LTIO,y and Cwse W w

Lilt, Ill NU1Sul urddlny Is roil c: .f,&JL' eo Cunyl,uCliOll 01,Ow IyountlMulapMGDntailnarc Fil,11ndII OnorM IrNm wndielr6 it OIarY . an all lilt

MIr boo M; Each Or son 11o,inQ r&z '0oul s .DHar,Ces in i.ny undal Var, io1* Ihallrti air IWUuaea

rxyw coriia.ne, m,,11 lox f oo Idm nu Alin Ihari Jul y I Itle1 i A lei OClobtlr Paiw ` For LICK lam T eIYO 1 $10 tae -u11 04 pl OAL40 Thal Ta

l19dr1 pot n vSlot Irian Jan Aly 1 19es Ip Tam& uses on llrrnyl goire sial ons pay $ p ' lwrw

peeteligon 40 U/wiMprwm/ QwMrIer1 Ti IA . APOWL IU conceit Fy yc Fur 164wa to lw II't wnany it $5W-$5.DOO Par ay if you lalally

,~ .. . . . lunWL rron.runL-O L,,,wo I/neb a olae unnergruuno cunlltirprs` I WITS : . : illolrtyl,dn you Lon brhrled uli JL $20 D00 Iar oicn all Inc wilornlanon b

KV>Al IWnlnlrrr, j IOrmd Allacn all (corn Iog~`Illir 1bcurllly 11 you Own more Irian

01 1on Dl oK&LVdiOtin

Sub/1Mw1l Ar r o)L(OnL sled tin Setifun 6.31f2 SO b oo you Cwn 1«e ,niumllgn on Cwnpule, lope Call fib/12A 1262 lot

In cinv L ade, Cr#c,:r' in SBC4on 25 :IG Of to haaTlc Ina 5/11e1y Caar

Thl loll ormanwlillci ml, Ja dJ4Ul a!`kriIuel an mou511 wl sur0rnlh poolC,do . rkMG,crdOC '

. is n04 ► rr1111 , 1licost n. AP unce-rprouno 111 wall be cuL-wcf 10aria Ium,0.ni5 it Irk n,alto&I mu01 DC Cdi, ,ea by t T ihlelto r,au+e• oh s

Os her ley piesiWC d , IO IMAI lrlguahon Sjdrne ,nw .chon6 heva ri,eady begun pi ogranl6 ChOCk- t . uii ,1:AD ypulwd of hit a na]A'UUu5 walla! a.' i s

11111 Or OtL OMP01 ilUm Co woulO noon nunlonmOI wlllltlu you mew ivgswi wiinyOo, IOLALCOUrly Q04 8in(nil l lot LYTht, ltOirrial.on

NOTE ALL U DLFI(/ROUND CONTAINERS MUST R19GISTE14 VIN IF STATE AND/011 LOCAL PSRMITO ARE IM POIICE

I Owne rST,. Caleihotr• Ino.va. . W.C a Airnr,l.

logrxmo And s ,.nlps Trill .ru OCIO* trio 110101al p,vond sun0IL ravel "Tollwry: II you nInt lnlwmalpn IloiKled by traor Secret laws

melee, Alrm &mnv or The ground is nof Included Conia,fw,s ( .ariioli yl .

not no 1A KUIiWi11...rn.Cn1 loll S melnipnyhclr Onihl6ldrrri toll It Cnrllieenai .Twine

. a O

'Cc Lie o ClHirr 13, 73, All CCnI1 T1ierF ndluloritj t lrlnen w11k'C F.ll . P0" (wOrr, :C1 and 4a1, hoot begin COFFtrill O

Hazardous Substance Storage Statement R 55 - 4-0a .

►rlltornla l$sr eaowcre o. gI a SW a ;W R ` CCa

VDQr, W F•u.. 6AILPOIL %D N - EL SEc U POOa.- AMA,; r'° Y

22,30 EAST LMPMQ.IAL 61 W9 EI.SEG11UDl)

11 F.cINty

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINE R

IV Dlrecrlptlon f~/

dnPit or Pond Cl w OtherT Su ~' L

e..r1 .r11 1 .1.15 i1 venr ,1 r4 n.arwer ...vrl onc e

s~oank ❑ ccA ❑ n mp I

B Manuilcwrer(l appr Gprlale ) Year of Mfg C Year Installed A Unknown

D Container CapaCllyrS. _'- gall0fl$ ❑ Unknown E Container Regalia ❑ o, None 0% Unknown ❑ In Yes Year

F I. Container currently used? ❑ w Yst if- No It No . year of law use aj Unknown

Cl Dorn the Container Store (Check One) /o Waste ❑tio Product

H Doe. the Container Store Motor Vehicle Fuel OF Waste O d" ❑ ei Yet if w No II Yes . Cheek approprAU box(es )

❑ o, Unieaoed 13 w Repuwr ❑ Tia Premium 0 o Diesel G a Waste Oil ❑ w Orhel (L ist )

V ContWnier Construction

o ur1 $S'I

rL .0 STD) N t=. S -be-Fpvm. r . . . r,p

w _~. o SXA.S{rw, Amp.

j T

•.

1. W1wjeso

(/~ Lam/

Cald,A.• . I zw

.yryw.alli 6? 3 C a N OG A Vtss

cft 1r.

CI NDC A.'PA t? aC. A21

1304Fb+ .. rw cone

3ddl8 710 C.'Wr h 1,warli.

otnar '❑ oo Moe Il ietlrcle, Fuel S7a tion A'.

MAa,r u r.r.p ao .w F", Rigral Amiga 'Now =6i

T74ldKrs o.dr 1 7111 24 Haw E1nrrg .ncy Cont.C1 Person

.4p,,. NMr I- T t ,.ul w0 lnta. . MC . rm

- iI .AT[TI11fi seLviGl s FIRS. o€Pr d ►L-3/1q r a s tLift . 1010W ruv,wn . i. .ll ..n 1M.. r e. -

0 Unknow nA Tnlcknest. of primary Conlam mb n I 16 ❑ Gauge ltnchas ❑ c m

d ❑ o Vaullea (LOCaleo In an urloerpround Vault ):- ,, Non•vaulled .. . a 4, Unknown

C E) o, OOub10 wailed k Single Wallyd ❑ o Lined U w Wrapped 0 w Unknown Ow None

D ❑ w Ccroon Steel ❑ a Sta,rlles6 Sleet O oo Fdxrplat6 E3 la Pdyvinyl Cnldrdo'A

Gphcrele ❑ i1 Alununurn

❑ c Sleec Clad ❑ a Bronze D o. vompoale ❑ ,o n-metallic 0 „ Eannen Wag s

d ,v Unitnown [) i) Other

E

❑

D of RuDOer Lined ❑ cc Ai Ulvng Cl _w EpO1y l.Nlnp ❑ . Pho rld.c Lrrorlg ❑ a Glass L .nrlg ❑ at Clay Lwrn g

1/o Urlt, ned ❑ .. Unknown ❑ w Drer _

F G F'colyeln,rnr Wrap ❑ Or, yl *I apid- Q ED ~' CalnrOO„ P,coi i c1 ED w UnwllOwn Non, ❑ w DTIttl ~.

HDMSe00106415

A Assoclaled Piping ❑ m Aoove Gro und . . . . . . ❑ o: Undeiground ❑ ,, Vaulletl

e Underground Piping CJ cI Granny [I,,, Prirssute Q no Suction 0 cw Unknowo-

C Piping Repairs ❑ u None ❑ I : Unknown ❑ of Yes Year of most recent repair

Lt U

VII Leak Detection

Q w Y/I Vj6ual 0 Brock Inventory O -, Tile Grain

0 m Ground Water Monroring Wells D I~, PIe55ure Test ❑

D II Other.

VIII Ch mlc l Compo.Itlorrol M~t~rialr, currently or Previously Stored in Underground ContainersII YOU - ,•rAur : alb to IV-H nrr.r, nl)i iullulroo 10i'orriplulc TAIL 6uLc n

WI rc u~utl

_ ❑ ui

M __yuua onY • ~~ -"t j

_ Oru

Crwaus lx:. .. h C-.- Q- -0-1 JaW' 1 .

❑ v ❑ c

Doi ❑ c-

D '

Out ❑ w

Doi ❑ m

❑ ol ❑ w

IS Container located on an Agricultural Farm? ❑ :n Yes

apori Srutt wells 0 . Sonsor Instrumen t

0

IXIMPORTANTI Read instruCilons before signing

$IprlalurU : Tne Iorm must be 6igrlen by 1i a principal ao .cunve allcer at he lever olvrce plasloenl of by an Oulnor¢ ea repreaatllaeve r rw rapt ■sallrnllrc

multi b& reaponolble lot the 0,1'811 eperaPOnci Ina l0Cliny whole thelariki6l are localed 2) a general parlrlel proprleloi, or 31 a principal e*ICUirVO driCer.

rarlamQ eleclaa ohClal or sulnorlree represenlalive or a pubic apr•nC y

Trws loom nab neon completed urlow the penally of perjury ann in IN, best of my kmwleUQe is true and correc t

5woAla

P,rllnli NormPww w • J.eh Cllr

$orld aMck 10; Hazardous Subaiance SI aQe Slalemenl Stale waterHeaoraces Coniiol Board p G Box 100 58GarrmLO . CA Bb&)l-0100

(&q) 7CK~^S7z ;

For addluonal forms or more Intormabon call BIW334-72&2

FOR STATE USE ONL Yr0 µ .iii- co,..,a, .no..

84 U&97

HDMSe00106416

L)TTIlaal riotp!i rilpnn r Un11

Callfornla WaterReeources Control Board

Hazardous Substance Storage Statemen t

Who Mual Faa : Earn written wo. riy n,irunN~i~n aun u: uli m my aMhx

4 llnI I (N1

;111 rvi9,6611 edNYlnul musl llW INN larmrw lOipr vian Jul y

1 .1964 and nn INU1 than JYnuary I 1985.1IA i 1C;IJ NJ IIum1l

OMMgen of Und,rg roundComalnrre: TIN- low ,111011^1 m'tsnlr111

lumps. nonvau lled bunrld 0(0k 01 affirm tiiNksl(rOWel (lea,pr'Nu IWdun

Coca section 131731 All containers InGluin(l iNitih11i W :ir.Nl p411 lomnelh

ligoan and Sumps Ihal art) bi llow the 110/311111 gluurkl Niirf111 .e luod mil)

register A link silkng on 110 ground is NA ii .clotlLY1 Conlonirn pallway,

:beneath the sunlce are vicJudea tined or 1AlM1rllIl pill pu .kty .vkl lagl)U l,

Iii Covered 11 huln has 001(1 ramOvllO Irum Me f1foruglr /da litcovnNul :1

the IscA1y. Ndimil grading is nab COnsidreod ConWlur6Wl auiuw ypuu W

wooOsnnlbon of Natlrdoul Substance: Any sull%IanCe Union In Suction 6 .76 2

of 111. Labor Code at InSeckun 25316 at Isle Health and Sulrxy COOS This

Meea1 9110101 62741 JUet : if 1111uslr4i1 aOlvurlfl. p.Si.Clw,e 11Hrai0ldae

1 and lumiganli II the malarial mull be Cli nil by n regi510111d haulm *2a Iaw e Jr l u oPP0~wad th at a Mol.QOiir waste site . NJ 0-pls.- yirrki1Ytuf p e

rural Or . tlecotTipolIliUn of vmuid hlrln hum:rnli of i.kilIc you fliuW 141951 1

ON, 1.01h W.- "M It.hi l

Pei . Iii . .kal nXlk li n pNl . .. NJ a $ IO IMI 11110 I1, pa

yuxid/iaNaINxn . Huy I . plO lank

6,111 111111 ,ct4 255 41a

Penalties : I is I il i .rl• Iii VIII I1kl lllinany is t :dxl S(i ooll pix day II you lalaiy

4610114ANxl: ynul1./111IN• 17016 Up 111 .120001)ILW 11618 day the Inlixm 4 h1(xl I1

411:11111,11 alai lui, INN 1001111 lii11 l3d

CenfId/nltaill if you have ,11uirryaWn p olo'clnd by 11100 secret Awn . SSFMeow,

I. Area 1]Meow, dhruha hit 1N fee iMu.nlenon on Inn; form Mal it clYkderiNd and tnuIwiili1 ; a1Wn ha l ;01( 1KIIIf11 (a14 y 1Y: k0Drq "ASK; 01111011$ Ol releyam IWIU

Illy will 161X, Lis

Mulkpl4Conlalner,C Fill I dnd if on will) IWinAnd lukvd it blink on INlh,t

Iuln.N .rAi lom11. Allach AN 101rh1 IOgllhur Ulcuil,IY x you 01x1 111 01 0 Man

50 tanks you Carl f ile inIOrmalkln on campulin ta pe Cam 916/ 324 .126217

lllar nlahi m

This I . not a Permit Appllaadani Al Undn9round Tanks WON h0 sub Oc tI TOkical raguhl.un Some Iwiscilc KNia Slier ilkeidy arlqurl programs M.with your local COunty g oviNnfhare for further IMOrmellor i

NOT[: ALLUNDUROROUND CONTAINERS MUST REGISTER EVEN IF STATE AND/OR LOCAL PERMITS ARE IN FORM

I Owne rNow ICWM i .rl 1,0.06110 11 . *v. I

Rockwell International CorporationOr- Ad&-

600 Grant Street0PA

i w

1521 9Pittsburgh

II Fealtyspry Now IN• .r. . .i.,iri ,y. .+.s.

Rocketdyne, Santa Susana Field Lab

Woolsey Canyon Road Valle a DICAW j wChatsworth

. . .

VenturaMil Aaw .w. .a, rw

6633 Canoga Avenue (LB07) Canoga Park CA 9130 4r11rw .rr .. cud . .w a sw.,i ..

818/700-5726.

ON Moor Vehicle Fuel St all on )per other' ~ .

[IM/tend Trl. r .w tw.y AnaaR1irul T .,.iw. . 10111 . : . e .cw1

OMr

a.n *0 . it rota Will rr Fw1.r/r.. coot wlp•• N .xW 14.1 wir • kw Win ft-

J .r.a rw.

H . Keller 818/700-4608 rotective Services 818/700-548 1

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINE R

t

x Min Tank El &gnp El w Lagoon. Pit Or Pond CI'u Other . --c.11Mi.1.~1..r, 4 n.,v n m none. . n.p1 Onir,

B/204 Raste 04 1B . Minutactluer (if a pprop riate): DnknoTlrn _

-. Your at Mtg .. Unknown C Year Installed: [(Unknown

D. Container Capacity: 1;11141. gallons 0 Unknown E. Container Repairs 0u- None (Xw Unknown 0113 Yes Year .

F. Is Container ctmenty used? 111 Yea D or No N No, year of last use 13m Unknow n

O. Does the Container Stara (Check One). 1161 Waste El ai Product

M. Done the Container More Motor Vehicle Fuel or Waite Oil? Do. Yes E]w No N Yes, Check appropriate box(es) :

par Unloaded O 111 Regular 011 Premium C) m Diesel Q(re Waste Oil Cl as Other (LisI G

V Conlakter Conatructlan

-A . Thlclm.aN fPrirnary 00111. Cann(, . . . . -- Gauge Cl - Inches 0 cart EXUnknownCl

8 Dot Vaulted ( Located In an underground Vault:) 1717 Non-vaulted Diu Unknown

C. El or Double Walled N ■e Single Walled El w Lined El o. Wrapped Elm Unknown El a Nona

il

Wall a

Concrete 13 AluminumO.

O

Dm

of

Carbon $

tCladeal Oar O

at

Bronz e

Stainless

0w

about

Carn

El w poadu Flberg

l i.

taal

Nonmetallic

oIyviny

l 0 if Ea

Chloride

Earthen O

as

is Unknown 0 .I Other.

E. Got Rubber Lined 0 or Alkyd Luting C

Do-Unlined X] a Unknown 0 m Other

'. Epoxy Lining 13 w Phenolic Lining 0 as Glass) Lining 0 a Clay Lining

F 0 at Poyethiene Wrap 0 to Vinyl Wrapping 01,1 Cathodic Protection .~.iw Unknown 0, ,, None Ow Chher

HDMSe00106417

VI Pipin g

A AssOUAICII Pgnrxl ❑ , Ahuvr' Cruunll Q0 Unrlrrgrn(o nn 0' . - V .1. 111M

H Underground Piping W ra-Gravely ❑ .•. Pressure ❑ -, Surhon OI.f Unknown

C Piping Repairs On, None Unknown ❑ n, Yes , Year of most rerenl repair

O nr Visual ❑ (4Slork Inventory 0', Tile Drain Q ,m VaporSnH Wells O1r, Sensor Instrumen t

❑ rw Ground Wafer Monitoring Wells ❑ Pressure Test O • Internal Inspection 0

Cm Other

t Non e

VIII ChemIcal Comporltlon of Materials Currently or Previously Stored In Underground Containe rs

r,nneyyrv,yr

.

ci..,,~J in, IWV l,4 C,.,Y.-n.& rh,n~ ,(M,• pollnW P1 ,w In. nw,n reps .

y,. -,l CAR I I^Vrvw,,,

Waste 0i1

❑ m ❑ m

o El

On, On o

Ono ❑ m

❑ ul ❑ m

El . ❑m

on- 0m

❑ pr °'

00, O r

❑ ur ❑ na

to Container IOCeled on an Agricultural Farm ? O no Yee d[' No

255 41 6

IX IMPORTANTI Read instructions before signing:

Algestura : Thn form mull be signed by 1) a p rincipal executive omcrf at tna lpvnl of ni e•premdere or by an authanzp reprasernepve r ns raprnemenv5mtlel he responslblq for the overall opmelkm 01 Ihn facilitywhome the IOWA) em IocdlMl 21 a genllrat pennrr prnpriolor, or 3) a prlnClpel exeaui rve ollicM.

ranking sleeted d11cl1r or 7W1, on7rid reprMenlnlive of a pubkr. agency . . ..

This form has been completed under the penally of porlury anal to the heel ol my knowledge . is Inie and coned

818/710-257 7

eland shack lot Haznr dnua SuhalCnrr. stprequ Simernera Slob Wnkv Reeourem Control Hbnrd . PA Box I00 . SarnrnMo, CA 08871 -010 0

1.,r., r ~ rn,, ..r

Michael Francis 818 700-5726

FOR STATE USE ONLY+ry MmV. . ('nr,ry N, .ntlu

0n' Mco-1

ou are not requlrkd to Compleln lnh seclrnn11 ou cMJCkerl yell to IV H :

p n, C e'

HDMSe00106418

0111r :Ind Rlnp ;4lrntiiln Ftlrn l

California Water Resources Control Board

Hazardous Substance Storage Statemen t

r ho MuM rw: Earn potion ■tonny h .lru.tkilt. ,Ha1111 .Ho II' -. MI .-y IVFn .al H . n..uw ~. w. xwni .255 41a

prutMCW ,1n,"fr Wt 11W this lam no Irlw Ih.ul Jlay 1 I 9 114 (Mkn rkeuot . Foe. 1 ta ,•,H 11 UK* 1 . tMrhrnl Sit) lint ntrwl tar Aral uauJyr 1nr11 rlin.l

:I . I96a ina no help than Janitor, I .19115 1' . L.* .-I tit Imemn) W.*- 4NH+w Pity 96 wit uvw •

ONlnleen of Un1Nrgraww Contaktis . : Tarr 11W .11rpkt ~ hr ' GMh :r.rht• Forty $ 5: I ta I;Ilha .r In Nlr no raa1MMY M 95000 11 ..000 ran nNy 11 y,w IWaay

lrlmpe, nonyWNra huliod larMttu Of olrra 1x .kr1Q1- .mv1 t.IMa .laMrl . IW.H . . ■ MW .I..h1.1 px. lain b. Lard up 111 001x 0 ku .r,acn .kly 01 Woof"WraMl FS

Gooo wcllort 13173 1 Al convenors mckih)U '10th" W.IMnI WMIM tall-rrlu .1 urr111 m tall laaal curtulJW

llh: noa ari il 'towwcrM lever.kiwi "W"tr kr u prt ytrutrwrrlpuon . .r .a :/unripe Uwl .m but" WA rkxnu Canllp .ntl.a1/r. If you have it-1-on SSFT. Area IItln lhiY form trim W CwMMrrr.l end lhckkknl C.xllMrrrrrSlarWlNr st to 01 Mretnlallal apluoW r tn

aLna f

i. . . . . . . 10911110 A I" ..ling; on Nre 9roUI40 M al4 n"

b.ne.lh this Wacor. ndtdrd Ln .d or u1MInL'n leis pu"n"k I1tl IauIalni powwaryln ha conluk tally dw J14 Mpm: iM : 1,1111114fl Of IMMrenl 961u.w: l

&@ coi .red it earth hale been re motes hUm 11W eldugrr Meta In roxnNa y .JMI CIIWrI . w

Irr. Iaarkly. NpmM gr .Orp srrol cgnWlnod cdlMkuchlun .iiki!W ValMWllpt. Contak w.: Fro I e nd II onuiiu loth H1r110500 A blank on ea Inn

l thane1wn wally lalrr> Au =h as toinul loQullkx erkaMadl n you pwnl mulawof IPwan al M.rard in Eub,ul531 A1ry wnst.nu h{Iatl in 4u[tIWrB362 60 tanks yrs . can Iao rllorinuan on compuw lap. Cal 916/324-1262 hi

q Ih.Lao Labor Code in in S.uax12316 at mu K own and t3.lnly Cute T rr. Nam. lalnNicaMle nwalc~a0l b 110wtinlr Pu p[cludof 9e .CMne. diesel fund. ae rndurkiM W This 1s not ■ Pannll Appttcaeonl AM Llfloer9rauna Tanks with he .unrWa.d h .IAe. Chockar ua py lruaay oagun programs1gi NIh rrWertftws! be Cisis nanywruare . i . Weal r 1.411 90111. ryrarrWlCIM.

M Harr

a n.a q Ww que,w. uue l014{1vu rl .nanh Mi

p ur w rrpal.d of M a M l .rdou. w h With rau KcM CUwNYSlfY1xnlnwM larlurlnM Or rnkade yule nwfl +r¢71hrim hwrWH .host or dM -omPe4hon or woul d oad a

NOTEt ALL UNOERO1tOUNO CONTAINERS MUST REGISTER EVEN IF STATE ANWOIIaOCAL RLRMIT9 AIIEIN FORC L

I OwnerNa IGnuwn M.utl. N Pi. Ire. Iwr 1

Rockwell International Corporatio ner..1 entree.

600 Grant Stree t

II Fectllty

6633 Canoga Avenue (LS07 Canoga Park; CA1N. .Ir .rr«a.rr Iwp. .

818/700-5726 011 Motor Vehicle Fuel Station ]pw Other'-_

...Iw. Nrrr •IT.r .'

Pittsburgh 15219

F ..uy tae. .Rocketdyne, Santa Susana Field Lab ~wM ul,.. a.. .a

r.. Ah

Woolse Can on Read Val r Ic ID-117

dp

Chatsworth Ventura 1

rIU Mp T.rr. M 10.1Maiia.l. Rural Areas

191 3 40

III 24 Hour Emergency Contact Penton

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

A. Mai Tank . 0 Surnp ❑wLagoon Pit ix Pond C M Other.

yrlknctwTI9 Manufacturer (d appropriate)

D; Container Crap.City; UM gaiio s ❑ Unknown I E . Convener Repaus: 0 .

C ro-l-kI.1 .Fnhnr .It .... a m Iola. d1 1 tIM I

Year lnelell.d: CQUnknown

F. Is Container CurronfIy us ed? Igal Yes ❑ m No N No , year of laal we-

G. Does the Container Store (Chock One) . N U. waste Cl Product

0m Unknown

H . Does the Container Store Motor VenicJ6 Fuel or Wawa 04? C a . Yes D el No N Yes. Check appropriate box(ssk

Unleaded 0w Regular 0 os Prelfuum O a Diesel alb Walls Oil C .. Other (LIt1~ ---

V Container ConelIructlo n

E . ci to Vaulted (Located In an underground Vaull .) ]d w Non-vwled O to Unknow n

D. Got Carbon Sleet D Q Stainless Stew D 111 Fiberglass D w Polywlyt Chloride D a Condete O to Aluminum

E Doi Rubber Lined D to Alkyd Uning O ~ .:. Epoxy Lining O w Phenolic Lining Car Glass Clung O on Clay Lining

Dui Potyothiene Wrap 0 to Vinyl Wrapping I] .. Cathgdre Protection (~I• Unknown O ... None 0,* Other:

Year Of Mlg T nknoown

HDMSe00106419

I PipingV

O n' Visual . . . . ❑ Stockfnventory Q ,o Tile Drain ❑ 1.. Vapor Sniff Wnps ❑ •r; Sensor Instrumen t

❑ re Ground Water Monitoring Well s

0 in Other"

Pressure Test ❑ im Infernal Inepecbon 0 .h None

VIII Chemical Composition of Materials Curren tly or Prerlousfy Stored in Underground Container*te IMa section --lComp e

Ilyou checked a to IV-H are 001 requredto .

r . . w :. i r...w~-•:.r Odin. ~uiw• : r wr.i a~i.+ xr men' .1P ' I

° IIIIIIIIIII I

❑ ol

o m❑ b ,❑ br

I I I I I II I III I I

❑ n .

❑ o1 ❑ ie -A

Waste Oil

iilll lll ll l

II I I II I I III I

In Container located on an Agricultural Farm? ❑ m Yes 11 No

255 41 6

IX IMPORTANTf Aced instructions bet one slpninqw~~M

ttlgnalursi The form must be signed by I I a pri n cipal eneclrlwe dher • r at Iho kwr•1 of rlrp• preadeni or bylan outhorized nip ~e1 M ;

mull be resooneblo for Itlrrovaraa oparallnn of the tatAAly W11nre the Innk191 are located 21 a gtmna M

ranking N$Cled official or lu homed roprotni Min of v public,agonC Y

Th. form has been COrrlploled under tie penalty of pCgpry and to the Will d my knOwk•dge is Iola and corroG ,

r

FS.MHT rr~J • 1

Sand shies Io: Halordnu6Snbtuarlte Storage Slalernenl 131nly Wnlr •r Aeni nel:na Cpnlrol tklnkl . P O BOO .100 Mao is M0 . CA 06501 .010 0

Michael Francis 818/700-57 ?&

For additional forms or more tnform*Non .u gle/324.1212

C. Piping AMaire Q n None N , Unknown ❑ n, yes . Ynar of most from repair

A At:z;ociel(7dPip.n 1 ❑: ~ .AhuvrGrrxuul I~ ,~.-. Urxlergrrxaxl . . . . . . ❑ ~~~ Mulled

8 Undotground Piping IQ Gravity ❑ . Prenellre 0- Skjoion 0 ., . Unknown

VII Leak Detection

FOR STATE USE ONL Y

F .n0•

A,, , . . .n .r M .H.• Ii ./Ilr . rNnm

O n. ci R• en 0.e

Official Mealstrttlon Forrnrces Control BoardResWat ouai rCalifornia

b Sto StttHazardous Sustancerageaeme n

Who Must Fit .: Eoch p+'rson otnrlnq haterrlotl SIiD919r - In nriv undrl If,,, ianl' WonroS mr : inrlurb' I

prOmid contanIl nR191 [Ile IWO lr,rrn no ;ilel then .III . I InH4 IAIlir OCIOCPr Fee : r -I Lln1: regslcr~ l h Sip toC must be paid. Cxrept that retai l

1 rng-l Ind no all Ihnn .1n11ilary 1 1005 for Innks u61. l Igrr'91 1 ai,un -III rm3 rift $Srl0r to N-

De finition of Underground Contain ers: The law ar)p11r-, h . . ..•onrr'•IO .. : . Penalties: l0IC1r'lold" he penally 5 S500-S5 .000 PIn rlayIIyou'nlsdynl r

______ 3Orr ps nnnvpllllcri boned In 11 15 0, olhrr rinrlnrgmurio . ii, -'rs tile r

Cv ,z encl nn 1 ;30 ; 31 ,1II COrlianlnr9 mrludmy 000000 fill 11 1 ll~ 1 fi rIna r, 1011 unllIrt Ihol nrr h 6 o .v llir r ,rlnn ,I nrotl i murldcl 1` I lIl' I

n?ulbloI I00k 8 111llrn on nip prnlnld iS riot nlclurletl . COnlnnn " 1'nrhllly

benoalh Ihr Surface fire Included Lin ,j tr ult Anti p110 . p011113 6,11111fir rli•5: .

r, II IIIC 1l ' 1;n ' .-o) hr Slorar gl arcs Inarc olirO ilrl oarlh hnO o0enrOm0Ve d

the] i3c .lily Noirnal rlrnd tip 19 no, r nnnldcrCO l'onvrrtiOl nn ill nrauni l

(it Ihr: LooofCode Or rn $1'010011 25310 111 . Ihr HOallh prod ul 1 . r .'. I Thin

1n,Iiiilne 9n5Ullrln )leer IIII'1 311 Inrlllnlrln ;elvl' 1119 pn.r'-r1 Ihierdo o

Definition of Hazardous Substance : Ili[ s1,11Ce llglyd r -llcn 330 2

I„Ihl 1 '~ rnob Iilrrilq.Inro II Inc r, llr, Al . moat hr t'.rurr' :i by a

poaod of al a h . -a'luus 1 .1910 S110 IS crplo9 un pr0r313lr 1 .r cur 1 to

000l .or tlecoml:' n 511;001 or would hnrr11 00man9 or Wllnlll , :tl il',1 -j--1

5Ormelro nr I1r IlInl O1 I In ht IIn 3 up In $ :0 .000 for oar.h day the r

n 611•' 1 , 9 nnl hr, Ir nlrr '1 0.11

Conlldentl alit Y : II ri hlvr' mint „ Illlill prirlr'rlrll by II0d0 900,01 1009

J.'10Ml'010,111 I Intl Ill the Iniormgllnn (in lni9 IOrnl (hot I9 C :Ontlderrbeland 11,0

un11bOnllon 10 l`(ui11d0nliril ly Inrludinp npeC llc Cllnllora Of Telev3nl 9talU

r1 :IV .111,1 r•( 1 r• 1 :1-A,

Multiple Containers : 1, 1 1 1 1 and 11 rn1 one torn Intl Inoue 11 blank 011 all th err nri,nurp In.l Attach all tnriiis 10gxlhor 50nllmly II you own more than . . . . . .

5,0 L3,iOn bnu COn Idea nlnrmnllon nn COlnpiilnr tripe Call 916!324 .1.262 for

rr nip 11i:11 1

Th is lip not a Permit Application . All 111drrpr0und Tllnkn will be Su111e(l In

r W Il l 11 tln Stmt 1,1n e;(lcllnne bnVn olllady begun prOgrnlll5 Choc k

.. 1h ;+iir meal rounly p0v0rnmenl for Ill, nor informatio n

NOTE : ALL UNDERGROUND CONTAINERS MUST REGISTER EVEN IF STATE AND/OR LOCAL PERMITS ARE IN FORC E

I Owne rImr'^ ICrxpw,11Ior . Indw 1 .' P :0:0 Aln 'n1:1• r

ar,n1 Anmren9rrvn )IP : : ::

4 A

II Facil it yF.~„~ n~m n

0 CKtF T r1i crow Sv .r 1Plnnr

1'0,1,11 /I F

a~Mr ~o(8, .s

Tao-s7z C ' I ,1 '•'lllr1 rllOl 01n0Un Olhii r

iIr h,. rn~ . a o1 " . .r,•,w, r ~1r rhm n,1 ..,, q,r, .nr ,

Only :

III 24 Hour Emergency Contest Perso n

COMPLETE THE FOLLOWING ANA SEPARATE FORM FOR EACH CONTAINER

( 8 i, f)7 -,S/9Jr q „ ~ (9i) r c fi ' 8 f o r errvd ,(l-re

IV DescriptionCanlNn~r Numb . . . „ 1, . .. . 1 ., , ~ ., .r • .•

h Irl Tarlk : . . ❑ ^- Surrip 0711 1 ag000 Pd or Pnn i ❑

B . Manufacturer (if appropriate) _110INIGws.+h1 "101 ul 'A ',j : . . UJIJ1bM. f C . (031 Installed . .. ___ Unknow n

D . GontolnerCapacity LOP- gallons ❑ Unknowr E CAA oiI' 9r,pali" ❑ ^ Nona It, Unknown ❑ r Yes Ynar ..

F is Conlainom,Iurr',nlly u rid? . .. ja'r'(on ❑ No IINo peirnl ❑ ,Urikny-.rr ..

( ; Door the (_ pnlelnnrStore(Check Orin I Waele ❑ Prr° hil t

H Does the' rrla',r'n Store Mblor VOhICIP ruel or VastI Ilil ❑ ❑ No II 1013 r hr, lpprn0natn li 'ii•s l

❑ r Unleaded C i Regular ❑ Prar uurrl ❑ r bir .q€,I ,AC. %vn'"In Oil C O hem (Lit :

V Container Constructio n

A Thlckn^o9ol Primary Conlalrimrnl ❑ fllurgo C If b . ❑ art TlJnknown

0 . D ' Vaulted ( Located in an underground Vnull l Non -n-lull' 1 ❑ IJiikrinw n

C ❑ rr I)oiiht^ Wellrri Ff I Sirirjlr, WeU d ❑ _ir,nrl ❑ r Wldppmtnl ❑ „ Unknown ❑ ' Norlr

D. ❑ rr Carbon Steel Q nl Ste 010 .00 Steel ❑ : : Fiberglass ❑ 0, Polyvinyl Chloride O I ,' Concrcl0 0 n, Aluminu m

❑ ur Stool Clad ❑ nnBronze ❑ ' • Compon il e . 0l-- .NOrI rnelallic ❑ n FArlh3r Walls

VIL, Unknown j Olh'' I

E ❑ u1 Rubber Lined d Alkyd Lining ❑ ' 1

❑ ,1" Unlined Unknown ❑ 1„ (]Ihr`,

Epoxy Llnlna ❑ + Phenolic Lining q r' Glass Lining ❑ on Clay Lining

- -, . . : : ... ...: . . . - _ . " -----__ .---_- -

F9 fir Polyelhlenn WrOp ❑ r Vinyl Wrotiplnn - fI . rmhnrirr", Pl of r,lrnn $ur unknown ❑ Kafir ❑ ' Othnr

HDMSe00106421

VI Piping

A, ASs0C1d 100 Piplny .. .. . ❑ , [ 111uv1i 3rou ld Un,lergtauuJ - ❑ . V ulled

$ Unoargruuno Piping. lg_ 3ra .lr, ❑ Prusduri C7 8-:ion ❑ . Unknow n

0 Plplllg Rupol 1 9 ❑ -' . Nurlu lIr1k, sit ❑ 'r r]s our it uiliol ICCynt repai r

VII Leek Detectio n

❑ ' r Visual ❑.- Slack Invontary ❑ • I Tdu Drain

❑ ,e Ground Water Monitoring WeIN

❑ - Vapor Snot Walls ❑ S&nsor Insir .Irlen l

❑ Pressure Test ❑ Interval Inspucuon x1 Non e

VIII Chemical Composition of Materials Currently or Previously Stored in Underground Container!•Ilnl:h1, Ir , r ul .I1

It you ,. rechr•rf ; . a to IV H yen urr : nrl I ..gwrrrr It..

cumnhly .l~pl<I

~wYCh .-A W.riF ill Io .JyJ r- . ,~uWrPril l

t1r,I ❑ :. W

❑ , . ❑

❑ i

❑ .-

❑ I. . ❑

III1i!I-I_IL 1

I9 Conlaincl I )Laieu url in AgriCulllao urlll"7 . . . ❑ , '

IX 1MPORTANTI Read Instructions oeloru signing.

Signature : Tho Iorm muss 6e algnea by 1) a prmrlparexacuuvc ILCt.r al Inr level 01 r e ,rlt ;ldeni or oy an aulnorizcd reprefienlaave The rccresentaeve

mu-l be ruspun31Dlir 0I I ha'X,'rall Uu€rOIIU( Cl Iho I~ialay Nnr n : Ii',/ .,nn -10 .l cowl 3Ounural porlntai prupoolcr Dr 31 a prmClpal ,r6r,~u,u cli .cd r

TIltS lilral has nor . r r:Ornplelcu Irhr5lr III• (:uilally la purjiry •,iItl i0 1 .,y . 1 1i,,y Frrwlmwo 15 Iris aria ?Uan; aranking uleCtoa l O hcial 171 aulhorlteu repiLSurllall ,r` ul a pnhl r . ~ .

I V Yc~s ealr lC Bi6V/O - zsi~T T N&r_.a ruT BuP.,nura. Nn,n c

land check to : Hazaraoue Sub5lpnro 5lurogu SlaINrlirrrl Slap, Ner.: . C„rlrrlBoald P O Box 100 Sbcr5menio, CA 95601-Clr i

For additional forma or mo re Information call 916/324-12e 2

FOR STATE USE ONL Y41 N. .n.rt. .

Dale rlacuiwC ❑ ul

Cu+xy: rw' .1io

❑ .l

HDMSe00106422

Inc talk Waslr: ■ art rncu.duduncua In any unde r

o Msrt Fall : Each per ion snoring nistsfOOua luur Wh ts re (NSlereq r $10 lee lateral DO pare .ac plthat 081 0

ler man JuIY 1 1964 (Alter October #4 : fog eacn Faiground r=Ontiir*r mWl h IS "is Idm no ti

~

1 1904 and no liner than Jan uary 1 1795 Ier larrks used on terms) pawarro atauons pay S p er tanrr18114

M111ea: For ladrwa Io the the penaI1y is L500-6b.000 per day M yOuDan~ al UseeFWa d Celq#lnran: The low apples to concrene Pe

r scrim nOnviWlod burredtanks of darer underprourk7 conlelnerl ( Weer epormruun you con be land up to $2(1:1100 1p each say IM 1NOimillio n is

AN CONamer [ rnC14dn9 eahen waled pxs panda frcptI tJ and "s not bean COnsOledrtCode section 191701ound

wrlar:e lavN mutl it you have ono anion pdadtsp M trade social lewyrN gr Con6"nowaW.lagoons and lumps mat era oNOw IM rro m

,egrsler A lank srlkrr0 onIhe gfwnd is not included onlalnals panreryplyake alUCh a list 01 the nNOrrtMlion an trot form that is CDMrOerui I pnd7M

alwn rot conlroontia y mcludrrq l{pecdre CClhOlu ddb lulu

tasrwam the surlaca are been removed ed Ltnetl a yawned pals porrdc a

ere Covered d earth hla bee nd W0ona Iusrarc n from the alasL area 10 Consllud Tory and Gse law 003 considered cl NNadfw is not d GdntlrurOn below ground larel CenWiesra . Fr ■nd 11 on not leave x 66ly~pprir~C~a IM

Ihr lacxny orrn prrupanorms I

W erY '~rary'more thanMrel luma.nng lorm

•tmancekited rn Section8962 i6/92a 1262 laks a F oyrrp r.ruGorr of tr rr auhela A53t ny fi0 si

n 2591bor the Heath said $aloly lode Tra yofliiiop. or

i d Ilre LaborCede of n BecIion ~ tEee ptaunO Tanks will be suDleCl t o

mck,des prisms desel lust as ineuWlal lovenls paslrcrdai i herbicides a )~pllca

a in* mater al mil be carusO by • registered haute OMbrun ra akrady bupun prnprAms Crackand IumigrNa leCrl

+

posed dl at a nataldou wash silo is esplo4W gen erates prossule due to wan alh c W IunrWr rMdmauian

oompOSMwn of would harm humina or wrinkle you mull roprilerMal or do ~

NOTE ALLLomfl onOUNO CONTAINans MUTT 11EOIITeF1 EYU4 W ITATl 0010A LOCAL P LIIYIT6 APE IN Ponca.

OHlcial Registrahan For m

CAMOMLa Water Reaaurcas Control Boar d

Hazardous Substance Storage Statemen t

rrraw ILoaarMon . roarw .rase warn

toto" ^owelli2730 6^S X A& p

II Faatuty-. o .r,, c or.w„ s.aw .+u~

oar. wnw . to r ,* Wu .r rtrrr .. ~ a. . . ...,4

IV DescdPtlw+

gar Tank 0

B . MenutaCturer ( rf appropriate ) Year of Mfg .

F Is Co nl adlar currently used? ❑ a . Yes Pp No If No , year of last use

G Does the Container Slots (Check One) ❑ or Waste I~a+ Product

H Does the Container Store Motor Vehicle Fu el or Waste 011? ;KW Yes ❑ w No II Yes . Crock approp ri ate box(ai)

.Other (Lisl) . ._`~7❑ o. Unleaded ❑ in Angina

V Container Construction

A Thl neD of Prima ry Coraa u

C ❑ o. Doubts Walle d

COMPLETE THE FO LLOWING ON A SEPARATE FORM FOR EACH CONTAINER

Sump ❑ m Lagoon, Pit or Pond 0 a Othe r

B ❑ er Vadtad (Located in an unparground Vaun ) % Non-v@ uaed ❑ w Unknown

"Opt Single Weled

D f y . Carbon St eal 0a, Stainless Slow p o, Frbeigl.$s

D ar Slao Clad a M Br onze ❑ w Composite D.. Non- meuni c

0,Y Unknown ❑ ra purer

rd ❑ Gauge ❑ Inches 0 cm 0 unknown

❑ u, Lined r,w Wrapped

Do, Poyetreene wrap ❑ at Vinyl Wrapping ❑ o, Cathodic Proteclan

None

year installed

(ZS1 A

Carwrrr .1 r . rnxr ..n in njrr.s. new'pa!

6 - 1

p it. Unknown 0 None

❑ iw Polyvinyl Chloride ❑ it Concrete ❑ as Nurrunu m

o3 Epoxy Li ni ng ❑ w Phenolic Lining ❑ of Gtias Un ing 0 as clay Ltrurig

❑ Unknown :

HDMSe00106423

VI `Plping

A . Associated Piping: V1. Above Ground 4- Underground ❑ a, Vaulted

B . Underground Piping ❑ ur Gravity ❑ u., Pressure Suction ❑ u. Unknow n

C. Piping Repairs : ❑ m None * Unknown ❑ oo Yes, Year of most recent repair:

❑ or Visual Stork Invento ry ❑ oc Tile Drain ❑ w Vapor Snuff Wells ❑ ub Sensor Instrumen t

Q Ground Water Monitoring Wells ❑ a ( Pressure Tear ❑ o. Internal Inspection ❑ w Non e

VIII Ch.mlaal Composition of Malairial. Curr nII r or PnrlouuIy Stored In Underlq ound ContalnarsIf you chocked es to IV- H you are hall reruturrad to Cutup WJhrs eeclrpn

Nor

❑ v

❑ or

❑ o

Do

Cb. SS l0, MO m Cooviecsl Nunb .( ll1o . WINZVWI : isi.r kv: mug : mg r

rods C.S . ur .no.mr

Dor ❑

Doi

o or

IIIIIIIIIII HIIIIII III II __

IIIIII H❑ m 0 0

❑ oY

H 11 1

Is Container located on an Agricultural Farm? ❑ ui Yes ~111111L,-- No

- I b

IX IMPORTANTI Read instructions before signing :

l lgnalure: The form must be aligned by 1) a principal executive olhcur a [ the level of vice prey: dentor by an authorized rupreaer¢abve. The representa tive

must be reoponerbie for the overall operation of theladitty where the lank(s)era located . 2) a general partner pioprlelor, of 3) a principal executive officer,

ranking elected official or authorized representehve of a public agency

This form has been completed under the pena ll y at perjury ■ nd to the best of myknowredgc is true and Correct .

M-i N.m.

TyA .~IkATot. PIxvW .w(wN um.

V ►

■endC hock to Hazardous S ubstance Storage Statement , State Water Resowces Control Board. P.O. Box 100 . Sacrartionto . CA 96e0l-0100

Pow F&V 6lrarwl

IC. C S~n.n. .1- C."

o0- x

For additional forms ormore Information call 916/324-1284

ij COPIES TO :

STATE WATER RESOURCES CONTROL LDAI [

Uw. rr.rxo .a ❑w Om ❑ ci

84 9767

VENTURA COUNTY ENVIRONMENTAL HC ;+LI iDEPARTMENT

FOR STATE USE ONLYdLIwIYi~1y Nu11111n ( :yoSY N11111r1a .

HDMSe00106424

COMPL[TE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINE R

Who Null Pea: Each person storing hauardoul suDlsancel in any unoar

found container mull ode this lam no law tharJuly I 1981 (Allot Octobe r

1984 and no tassel Inan January 1 I9B5 loi Lanka used nn hems (

O IIreUat01 k%W09n umd Cardalnlsa: The Law app lies to concrete

lumps nonvaulld butted llnka or other underground COnIalnert (Wait"

ANOL Cod. aacIOn 191731 As containers . Including sanMn welted poll pond snd auIl cl Iwel mullrome( u: Alagoons and sumps heal we below ma na

,nC udld Coil aioerl FantasyOn 1111 ground la notrlx adtirA qlarspallrbeneath the aurlaCI we iACIu11W Lined Or unkAld pas ponds and looms

h Ms been rsrtiov.0 I/om the storage OO to construct

nWI Covered d ead w durltlr t r

17senlaon M 1W~rdouaCl the LOOM Cow 0, in Section 25316 of this Health and SabOlY CAd1 Thl

oldte diesel ION g1 dldiralnal solvents pesticides hlrg,Clde i

ecO an" : Any Wb1lanie listed in . Iq

-ucthe facility Normal grading n not COnWas d const

Mull n 6382S

dictuon gasal mum be carried by a regulated hauler d11 .

lefn I m iaMand lumgasrx r

p0 sad 0111 a nazardou wama mWi It explosive, genMalp pre ssure ULM 10

FMit or o.oomposalon or wo ul d harm humane Of wsdkls you must register

Sump

NOTE : ALL UNDERQ11OUND COMTAINEAS MUST 11tQIST111 EVEN W'

ndorarourld I Brain WO on larm-vas already bogun pogrimi i liUCO

sunlit r dllpmaho n

1CPPOIWr or risk .t-VI

V

w .mma

2 XAAP

II FoeNltyy

IV Deacdplon

A moo, Tank ❑

Official Registration Form ioP-4.,c womlaWa lter Rs.ourcua Control Board

Hazardous Substance Storage 5teuemsnli R`55

0 m Lagoon, Pit or Pond ❑

B . Manulaclurer (it appropriate )

D. Conta iner Capacly`

Other

Year of Mg .

gallons ❑ Unknown Container Repairs ❑ of No

F It Cottualnar currently used? Co, Yet 5Lo No It No . year 01 last use L

6. Does the Container Store (Check Ones Our Waste Xx Product

aw lank Wa1hr ► Billdlclddad ,,.~«...-•~•~••••.

pea. F or each lank r ttarld ■ $10 I.. mull b Paid axcepr that 16164

gatakM pallooi-pay $5 par lan k

lrallaalloc For lelure 10 Ills Ina penalty to 3600 56 .000 Pat day n you Ial4ly

allormauun you can be lined up to $20000 he alth day the inllulrrlatlorn is

d1COIIUCI and halt not boon convicte d

Cpled1/1tsgaily: II you have uddrroalion prdtsdap by Bade 1OL(Ol Ileko0rddte 11i dielt is

pwese attach a ksl of the diunrte1 ,011 on this lorm ma

1ulhhl.ahOn loo cord.Oerlllaxly I ncudrlg lpecdre Citations . ul F

IOryand case 11* &11%

MWYpM Conlalnln: Fr and I( on onn I v0 it bi i 4h the

~rwr tnOl. UlanlYrurralr„ng lam lams 1 rr

e

60 lanwe y or pull , . 19/324 . 1252 for

H. Does the Container Store Motor VenlciS Fuel or Waste Oii? Kai Yes C w No It Yet Checkappropria

tte box(es)

Waste Oct a Other (Liss)

9015.0 n Vault ed (Localeo in an underground Vault ) Noll-veuhed D in Unknown

C Doi Doub le Waged Alt Single Wall ed 0 to Lined

i Carbon Sleet ❑ a Slalnleas Sleet

❑ v Unlined CI as Unknown 0 is Other

E, ❑ o, Rubber Lined ❑ m Alkyd Lining ❑ at Epoxy Lining ❑ tar Phenarc Uniting ❑ m Glans Lining ❑ w Clay uniting

Le Wrapped

Year In st alled : _,LJa[f -°Q Unknown

Unknown ❑ om Yea Year

❑ m U nknow n

Unknown ❑ u None

❑ oa Fiberglass ❑ w Polyvinyl Crdoride Cu' Concrele Do. Aluminu m

Q o, Stall Clad E3 us Bronze am Composite ❑ Iu Non-rnelahrc ❑ i, Earthen Wan ts

❑ is Unknown 0 u Othe r

F Doi Polyahlene Wrap 0 m Vinyl Wrapping ❑ s Cathodic Prolecnon 0 w unknown O an None P ;he,

HDMSe00106425

VI Piping

2-

I_1

B. Underground Piping : ❑ vi Gravity ❑ uv Pressure $,o Suelion ❑ w U"now n

C. Piping Repairs : ❑ or None oa Unknown ❑ oiYes. Year of most recent repai r

VII Leak Deteapon

if you checked Yes 1, IV-Il you are noroqueed to complete this aecuon .VIII Chemical Composition of Matsdols CumnII or Prorbullp Stored In Underground Containers

er ek.Mb .l lou Ntx U>•. Col,m c ivon 1u. . wdr,a,wr P„ryr. lox for . raarr

sarud CA6xAll wr .,wni . . .

pal Visual m Stock Inventory ❑ to Tile Drain 0or vapor Sniff Wells ❑ re Sensor Instrument

❑ ox Around Water Monitoring Wells 0 or Pressure Tel

Q ,o Other:

❑ a i

❑ m

❑ 0r

❑ u[

I_ -IIIIII 11

II II IIII I II I I

❑ oi ❑ oaLL. ~l

❑ o r

Oar

❑ m I

LI

ll ii i

is Container located on an Agricultural Farm? ❑or Yes R N o

IX IMPORTANTI Read Instructions belore signing:

SIgr iallNet The form must be signed by 1) a p ri ncipal executive olhcer al the level Of vice -president or by an authorized reprrsenlalive The repreaanla ti ve

must be responsible for the overal operation of the reality where the lenti ( s ) are located . 2) a general parlrer ptoprrafor . or 3) a principal executive oercer.

ranking elected olliclalor aulrwrized represDnlaIlve ode pudic agency: . . .

This form has been completed under the pena ll y, of perjury and, 10 the beet of my knowledge , is true ■ nd correct .

egrrrur.

Innl.d f05ne T Nwri. .wrr .. cud.

tr.' MT-H KLM(Ifir 1~~ct5 I

Isatiall check lo! Hazardous Substance St orage Sl$terneni, Stale WaterReeourcei Control Board. P.O . Box 100. Sacramento. CA 96801 .0100

D" a.a..v«r

r Ha TIRA N

For llddlllaml tons or mos. Inlornadon elM Yta32 -1212

STATE WATER RESOURCES CONTROL 13OAC h

UEPARTMEN TVENTURA COUNTY ENVIRONMENTAL HLALTI 1

FOR STATE USE ONL Y0 rwrrn.r Accuvrna rr,„ wv,

❑ aI K] w

Phnr wr no o>d.

oo 72

c,xxrv Nv,O0

ow

e4fl 7

a

HDMSe00106426

Official Registration Form

CNllomiS Wa ter Resources Control eoerd

Hazardous Substance Storage Statementi S S _ 3

Who Mleet Faa :Each person sloting haOalOota llubelerlCea In any under' I s arlk Waste$ am Irlclu00b

round Cont~nil mutt leeIks form no filer then Jay 1 1014 (After October Peer For each tank regt1we0 5 5)0 we Suet be paid exce p

ION end no SOW Iran Januiry 1 1985 la tanks used on IWAS) QeyoMnO stations peV 66 Pat t @r*

youIi1SO Y

DNlnliane1 Undirprouned Cpdpnne: The law atPMS10 concrete 'erWll.W Fa solute to It's the perany ii%5&i-55 .000 per pay Y

f . . . .. iounlpo . nonvPuaed Wood tents or ot her underground containers (Waler woormallonf you can oe lined up to $20 .000 $01 eCh deY the iOrrrattOn to.

idCl end has not Bien COrreClrthen waned pis porltle; 1luirC Orlme IrlOUding eaCode seCnOn 13177) All CtYaartyre vMamellan prOleClip by trade seGet tawsround ewlaCa level muteraxrral 11 oon .g y ue .lagoons am lumps that we 0alow LAP-momen-Y N mflrrder

A tank sellY1p On Wound..IM ound is 11d nCluded con aeMrs partim" lease utluCn a bill d the vsormakon on f ree form the is CON

u P"od" and laloens tuperrakon to conl .OereaWy . IfCiuomg speaktc CaahOnu dbeneathb.

n irScoveted

nhsurface moo been rd Lrrled or urwn .A o

Bra

:

If eart h has been removed loom the slorage area to COnalrucl 10<y end came Law f ~.,, .a1 ►`

Ihe sac tNy NonrW graQhg to not cOrwdWi0 COnsIruCiIOn belowground MuMple CoelNnari : to and 11 on dnr• t MY o_it k the

ri Nanmd

r, level Ieealrllrlg Ip m. .. :Igml 1 wNy aYlR

bounhoan Si IY11 415 WM1uae : Any eubelance seed in sateen 6787 erne is ormai~{'P o IgIS24 1262 tpro . inn aa Cy o25716 of the Health aril 8albo Code of Sr Stealth tnlLthe eOf

t■ -Ld. jgropay Teryls will DO

asoline areart 1u1 all 1M,Alral Solvents pdM.Cldes hlarblcides -ow ainl g e

road try a raplnuid hauler . bs •bwal 1 941 ve ekeidy ougon P1Wrameinc luoTionts n Ito maosell Suet be car

louve FSMtilea ptuu0 Durr toio sanulwnnp es lrposed of at a hazildeu l wills Ills a with IC tu

w.UMa you mull fegralefheat 01 dlooo lpO/eion ofwo uld helm humane

mom ALL I$IOIAOAOUND CONTADNIA$ MUST R[ CL1ST1LA MN 1F eTwT[ ANn1011 LOCAL M/1M1T1 Alit IN POII C

COMPLETE THE FO LL OWING ON A SEPARATE FORM FOR EACH CONTAINE R

IV DNaripdwl V-0 hor „bran .fMe1ayl. ~

A Cron Teak Sump ❑ is Lagoon . Pit or Pond ❑ w Other0

B . Manulacluref (d appropriate )

0 container CapacdY

o. YeB Giles Na d NO . year d IpT useF . is Cont ainer c~wrenlly used? ❑

G. Does the co nt ainer Store (Check One ) ❑ a- Waste ) m̀ Product

H Does the Container Store Motor Vehicle Fuel of Waste Oil? *~ Yes ❑ m No

Cc . Unleaded ❑ oe Rsguiar ❑ m Prerrrum ❑ o. DlesOl D w Waste Oit JK. other (Lost) -X1--1-

V ConWner ConrtrucMlyn

A Thickness of Primary Containment . ❑ Gauge 0 Inches ❑ cm ❑ Unknown S'c 11

S . ❑ on Vauiled (LOCeted in in underground Veun) w Non-vaulted ❑ m Unknow n

C D or Double Waited

Year of Mfg /96/

St$ . .p.wl .nu " oee.r I

-(

C Year Instated. - 0 Unknown

lions ❑ Unknown E. ContainerRepels ❑ ar None /'"w Unknown ❑ m Yes Year:

I [3 w Unknown

Single Wilted C w Lined Wrapped ❑m Unknown---0 Non e

A, Carbon a" ow SUrrdess Steel Do Flberpass ❑ w Polyvinyl chloride . : . , D m Concrete C . Alurlunum

C om Steel Clad ❑ on grate C or Comppade Ow Non -metallic 13 I I Earthen W1116

❑ 1 : Unknow n

E . ❑ o, Rubber Lined ❑ tot Akyd Lining C m Epoxy Loring ❑w Phenolic Li" 13 oo Glass Lining ❑ as clay LAng

O it, Unli ned ❑ n Unknown Coo Other

F ❑ w Poyethlone Wrep C w vinyl Wrappng Cu. cathodic PrteclIOn ❑ w Unknown ❑ ie Nat I0s Ott

HDMSe00106427

Vt Plplnp

A. Associated Piping : X~Zi Above Ground Underground ❑ n- Vaulte d

13, Underground Piping : ❑ or Gravity ❑ w Pressure K- Suction ❑ w Unknown

C . Piping Repairs. ❑ o . None )k:, Unknown ❑ of Yes Year at most recent repair :

❑ aI Visual * Stock inventory ❑ a, Tile Drain ❑ w Vapor Sniff Wells 0 co Sensor instrument

❑ all Ground Water Monitoring Wells ❑ or Pressure Test Doe Internal Inspec tion ❑ or None

❑ i Other :o

VIII Chemical Composition of Mntrtrlnb Cumnii or Previously Stored In Und.rground Contnln.rs

..v. lrrwrr.o

c CYOU

P,-%-v - : :: Ch. * 1)0 NW ii a Cwmrrtw N.0w IuW pnhaw n.pu : Nx n~01r n16It .

uu .e G6/ • in MfOrm l

Dal L]1oa

Doi Us e

❑ oi D a>

❑ .I 17) tit :

(301 [3 w

❑ or 1102

❑ ar 13 u

❑ ai ❑ a,

❑ er ❑ w

❑ or ❑ m

Is Container located on an Agricultural Farm? Doi Yea a No

IX IMPORTANTI Read instructions before signing

Signature : The form must be signed by 1) a principal executive officer at the level or vice-president or by an authorizediepreaealativs The representativemust be responsible or the oversil operation of the lacIlly where ire tank(s) are located . 2) a general partner proprietor . or 3) a principal executive officer.

ienkingetecled official or outhorued representative of a public agency ._ . .

Two form his been completed under the penalty or perjury and, to the best of my knowledge . is true and corrsa.

0w

S. A . Ke 1Ir,P_Tee Pnnn W rw onu.

JI C S PAFN~Sind Cheek to Hazardous Substance Storage Statement Stale Water Resources Conlrut goer, P .C . Box 100, Sacramento . CA 96601-0100

rwrun ru er.r.nrn

rkA c- k _a'AA -1AAeJ

nun . r, ro . wor

C 0 --7

For ttddlgorull loans or more I111orma ll on ca ll 9'16/324-1167

td trim riaCUOnked SS 0lV - H ou are ' not(equrea 10 coa lIf he

:• u COPIE$ TC '

i-STATE WATER RESOURCES CONTROL 50MV

VENTURA COUNTY ENV IRONMENTAL HEhLTI 1

DEPARTMENT

FOR STATE USE ONL YID Ntn-0r

D.I. fl-N ❑ (n

A(.cu.bq St air. Can, N.nrn..

❑ UO 003

8UE09/

HDMSe00106428

Otfic,al Registration For m

Cartomla W ebr Rssoiwces Control aoard

Hazardous Substance Storage Statemen t

1NIIaMIiN PI. Eben paraarnatalnp hattldoussunalarrr5s in any unotn ..

m I •Irtt'r LtlCIN y 11 yo. o~'n n1dE IrianRlaxrr loan Anacn an Iol L 00 eryr

INXIO C lnar muss IIk !?1I Iorm nO lfrkl InanJdy 1 yeBa tAlto' OClUd1r ; For WCO tank to ,rw&rad a $to to meal De paid "coo ow relalt

I9-4 and rw lat er Inap January~1{ ~1ye~s for Iar1( 5 useC on Iarmt- awkne slal .orYS Day s per ta n

n c vclsi C 9"MillWO! Tn6 I5* APP't$ I" CUMJalI planeelaa: tae 10 'At the Ci"Iy$5oo •115000 pm Clay It y" 1610yIIOd 01 l.

SumDS rlcOTI . *W16il Lul'ru Inhns 0' t.1 W yrlo1IOrWnO Cuntl,!WrI ( Aaltr lrltpn-al~nn yOU C a rl be IlnbO JP IC$2000010rWtn day In& "Ormallon y{

Cude cc[-br . 131771 AI Z . .nl5ner$ InCIL,Cf.t LllnMrr , waaeJ (AS ponuk Iry.CrrL•CI One not nOl DhtnCCnrCIOCl

~. . . laQOOnL ano oWrtpS rat are [440,l. i hr rl0rrral glwrld LUrlalC Waal iII..bt illamy . It you harre WCVntalron prOleClO0 by trade alCret laws

re¢L11f1 A IatM 411.n4 on tie (yCuno1 NA nWluooo ConlaLiers W.l .brly pwsb.C t111SLn a Us[ Or Ih6 NOrfw1 .in on this fun. Ina! Is cONOBnIa , and t rio

.' . bOn(-alri irie6unec( 51fl7nGUO50 .)n6tl u yrd r ..a p11 Pb/ldh artd Y {IUUr1b ICIa18'CSIIOntor COnhderxWWy IfCtu0ng SpbcdiCCd5110110 of ral[Lam slaw

Not COYMIOG It ears 11111 deell If' Ovto IIUrn rnt 9101a9L area l . C0141-0Idry and cab. W*

Lob Iacady NOrnal prabrrly •s n(ACCnr.aeled CGnpllucL0n babes groundeMrJYpM GonuMiarr Fm Iand 11 on one Inrm and leave it pan, on ON lne

w Wt 6782 .S 26' ec .JpOaeN1V6e pf Mfl.PigM sCr . Any suULISnct ILI6d InbSSaOSa

j- , Wr Cole a in Section :531b oI the n.,aun aria Sa1G•Iy C 50larrke you Can IaeinlGrmaLBn onCUmpulBt laps GJa 911611,24 1

ti a .JO . This udamnrcl n

Ono lumrpanlb Il Int r4alarltl mubr b5 CYmed by a re(flxl6rtd rwuWr WL

pv0Ad ul at afibl klrooob *5sl5 LIIC is r'yplos•f( g6nHSIBS preskurr Jeri' to

oil Or dlCOm0 0BIIIOn d wood harm riUhanl Co wudl110 you mull r(Qi Lllr

/1OIWe6 QasoLne Cl .OSeI Itkl du InJuLll161 y(xvlymS D6 LI-C IJ6S fIL°fDIGOOST11M M nol a penal App5CbYon. All Und6•rglounC Taroks WA be wAmtcl 10

I Owners,

IS'?..,C.uptrr+/I vq .s.Inu Y ,,n[ .AyrK, i

¢QLK W U. [_AA•{'ORAT1D PJ - E L SC~Cs h 10r .. r. .. r+IV_ Add,iiPUl

ii 3D €AST LNPl:21AL 64W y

11 Facilityrwr, w . .

MDI fX&T'0J N- Ape- .

ELSE&JUDD ACA ja102 5

Mr I—, LO.-

STNSIr.ibiYl Gou//~rN /

1~ CAND( PA R-1L~G14 A V

ode.

rw abrron

111 24 Flour Emfergency Contact Psrwn

ear.. hinli lUi wIw YM~ r o salt . r•r*i cr.a mvi•. 1rawlr Ilia r

4 s3s If

`6'a3 CFrN

BlB- TID 'C.3Qo

81&3R~TEETIY£ seLVlccsFlQP DEr

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTMNER

IV Deacrlp

A ❑ oI Tank ❑ m Sump 407 Legoon Pit or Popes ❑ w Other

1015 tarts 111Vyy1YSare rnCL Iabd

IOC 1 rtl(QUISI OO SOITR' Wr3JICIh0ri6 ha . a bheaoy DCQUn pO 2111% Crwc r

wrtr your IOC:&I COUmyO OvernmHx for lurlh5lylloimallo n

NOTE : ALL UNDIalQ11OUNO CONTAINI $ MUST II t31ITe11 e•Y!N IF STATE AND/OR LOCAL PERWTI ARK IN FOIICE .

B Manufacturer (d spp0Op(IAle) Year of MI g

D Corrlemer Capacrfyl 2 MW Itlont` Q Unknown

1 55 d 6.r,Ia.

❑ , Motorverxcte Fuel Station at 01

Contalner Repairs ❑

Pa+~we-zca

1__I~ rII

:Ir.ull srnr.rrrw. w► W'.wv ,

Year Installed unknow n

None % Unknown ❑ In Yes Year.

II No, year of last use pn + Unknown

0 Does the Contai ner Store (Check One) Waste ❑ a Produc t -To64 ,.d. I-'

F . is Container cJrrently used?

H Does the Container Store Motor Vehicle Net of Wa st e 011 ? OsI Yes ev No of Yet'. Check ApprOArlale box(es)

V Irw Co/aehucYon

A Thicknes s of Primary Containment Q Gauge ❑ inches Q cm

9 : _m o, Vaulted (LDCaled in an underground VauII) Non- vaulted ❑ w Unknow n

C ❑ of Double Waked ❑ p2 single Waded 0 w Lined a w Wrapped ❑ a Unknow n

D ❑ -1 Carbon Sleet ❑ aiSta rtlees Sleet Q of Fiberglass O o Polyvinyl Crlloi .ds Os Concrete Q u Alurtwtum

0,2 Unknown D o Olnel

E ❑ uI Rubber uMd ❑st Alkyd Clang 0 w Epoxy L.wrng OA Phenokc Lirang Cot Glass Lining Doi Clay Lkting

0 u• Calrwo , Pruldal , lm ❑ w Uru:rluwrl 2 Noft ❑ w Other

HDMSeOOI06429

A Associated Piping CI o, Above Ground Underground ❑ u, Vaulletl

IUw .n.M• . . IMW Kw . ~ :1 w'' .

! I/ /N 14 A

IIII I I I IIIIII A la Ac a

U Visual ❑ ,= Stock Inventory--- ❑ 1,, Tile Drain L ]w Vaprur ISniff Wells O in Sensor Instrumen t

p Ground Water Monlloring Wells ❑ , Pressure Test ❑ u. Internal Inspection

p 11, 01h «

uu Gnece u eb IU tV-ti uu Jlu nor IuVWruu Io cum Tlc Ih1 .. LuW~unII y

VIII Chemical Composition of Materials Curr.nHy or Pr .vIoylWy Stored in Underground Containers

.'-W Wino PAY 11 1

❑ ro

❑ o-

❑ o,

D ni . . . .

❑ a.

❑ o.___ . .

❑ or__ . .

❑ u

~111 I1 11 1 11 11 ~

llllllllllll l

11 111 1 1111 1 1

IS Container located on an Agricultural Farm? ❑ ., Ye s

IX IMPORTANTI Read instruc ti ons before signin g

$ nature: Tine lorm must tie t+gneo Dy 1 ; a principal oaeculne oflrcar at the level of vice president or by an ,ulhor4eo replarenullve The reprasenlatlvo

must be reaponhiblr cv Ills overaa operation 04 the IaCllily wnfr6 Ina 15011(5 ) are located 2) a gerlarat p artner proprietor . or 3) a principal execu ti ve ofllcer,

ranking elected 0116181 or autnoraed iepreaenlatlv6 of a puoSC ag6nc y

Truc lam nab Deen eomptaled under the penally of perjuryand . to the lies) Of my knowledge; is true and correc t

syn.r,. e

hxYU Nfl'Tun

80" Glte0I 10 : Hazardous Substance Storage Statement . Stale Water Resources GocL ul boero P 0 Box 100, Sacrttnlertlo CA 95801 .010U

PMW'Frp&run.

,1 ( i8) 700

For addlgon i forms or mor* information call 1I/324 .1262

FOR STATE USE ONL Y

U .w h onon ❑ i'

(n+.r nvr.cw

'0i

84 31691

B Underground Plprng Gravely M, Pressure jIu, SuCtion ❑ w Unknow n

C . Piping Repairs ❑ , . None a Unknown ❑ oI Yes Year 0l most recent repai r

VII Leak Detection

HDMSe00106430

Official Registration For m_ r 9rc Control DotardnI1W 1larl

flClWai oabd~ne o.ewl lue all nouf1lt bowenlY peal.e .oc•i herncc,le Th1q LflOlAMlraa AppYWYon AllUnD6rpr0urlaTanwslr.a OC WrrleCl 10

W cal Let [•y ea reyllfs pfem1, a dry 10 Will r t.I lion SOmF IJIrYD .UUOni have 6116110, oepun proprami CrIOCkand IUAf bi as 11 In[ nlalerlal $-Ie nU5v

k

TR

1pofa1tt

l 171 U Y I DYC0mp

dthp0f

.I.U

n tOOutr or nOW *Ot$O nYrrnnun u

rMrtrl nl nh d t M,ne

lIdr1 lde

• l6s yoo

u t Muir y 2a 14utt with your I0i.l1 CUUrwY porefrvn6nl lot IUbier "OfflAkOn. . ru(l,alu r

wMe, mom Pre : Earn prawn slur-f9 rtalalcouf 1u aala r.cesm Any urlacf me Lam w$Hrr are mu.+aed

prwweor twner mw kt Inri Iorm re laic-, man July 1 198 *16, OLIODer Per For bach LIrw ti iII Itp a $10 t*$ muu w Paz a+capl trial few

I i art. ito tl, IalaY l non Janua ry l I 9010, L A 1.. $ used Oaf larflu gaWMrt wallaflf pay S5 par Iar W

Pealietewlin r LA 1. ouU d CoiWrkofa Inc IAw appw.Y 10 Cdl0el6 P*naNfac I'Lif ladure 16 4AC thY penally Ii S 5iliYf5 UJ0 per Day Il yuu la•Wy

aumpn n0n, .uaetl LJI,etl I.rMY or Urrue urwtllgl "n0 Luruaincfs I*aler Yr rormuI .oul you Gan oe hruC J4 to $20000 tar OaCh OAy the VAOImal.pn .f

C.JOh sLcl,cri 1317l AIL Sonlaruers ncIr. fl r 11NLr *81410 prt$ Dc-ak Mr;piCCI $nd haf MI [rnerr. corlCele0

NOT[ ALL UMDEROROUND CONTAINElr MUST REGISTER IIEVIIIN W STATE AND/OR LOCLL PLIIYITS Aft 1N FOIICE-

I Owner

Lt>'a Fun tI

.rFoot r

Urun

in m' eluor fl, :tt Any suoslancc I pled ,Ii Setcon 6387 SU lanth YOU Can IJII .r10111 .11 r on cumal+lnl rape Cal 9115t324 12e2Icut

QI Irm•LIIAbw COOK Se

cpar`2 :f"fib' or Inv Flvalln ana Solely Coat Tnf Ywarnlaliun

off C6veretl 1I Calif) nai peen Iemove0 Iron Ihc . 0rey l rYatUtyantl Cafa 16 .

rrle Iacduy Nurrllal prlalnlj •5 nol LOnirUeleO cun,llUTtlon "0. Wound

16a1Wapha Cenldywn: FIU Iaha 11 an one Iwm and leave it den .. on all t"

IA a,mamirl Iluf mn Allpcn an lcrms lop[.ihlr seC,r.31y II yOr own more Ih h

eerw.1h Ir,r, lull YCL i.10 inL1-4,0 l+r,(•0 N unllrm- r- Ott Wntl ; and WgaorIS tlral .•callUn tour conl,annli hIy IfCI ..O.ng fpvcwf . cpnnOrli al lelevan Al .IOICOnfll J[I

afaa r NCaYlorr aHazardous SubstanCS Storage StaI& nt

taQooni 410 i ..nlpi that urr W.O . IN rwir•,dr ,I -14 i u1Y : ;c level ! this. C011Ndahtaaifr : 11 you nave /Uwmalbn prolecleO Dy uaO6 sacrel laws

na thala¢Yhn Ata M1. 411,n~ On rr,p yrGUhOnB nol . nCludetl [an1aHI('f i pafLy WIN a aIludh A bill Of (Ti lntOrn.Alr0f1 On lhli IDarr Ihai IS t he

Nanw . .-u ae.uun lno♦a.w .I r'a A9V Cr l

RACK W f L aWLPOR.ATI D N- EL St:G VA1 D ma." AGO -

22.3 0 9 AST T-N MQI A L 1,4W 1̀

tau., w• .

R,IUL -TDJNE. S5Fe-

c. .EL'SEGOVDE) CA

II F.cil ty

161oa3 CPrNOC3 tuVVNr. w aa. CaO.

t318 710 C03,00ll",hp ~ n 1ap.. s1 tip

37 MKK5,Aural AroftO+Mth _ _

Ii 24 /towErnseg .nCy Contact Perso n

0ar• N.na iu ., ,.w.w Y.. we -.- 'Y.. ale My. . I{ ....1 WV .YC ... ill, r.C F y . Stun CPI

?R.OTECrWE SMI4l.S F UL DErr 419-3'14 Z a c

COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER

bay . I ulfrJ .r S w•, ,a

Me- W .7. STI S

A. .

C& ND61. PA Q C A

90 IZ 4 5

91304-lye a ew.lra. • .:

❑ Motor Vehicle Fuel Stati on p"w<Olner' >l~- /~1

A~

. . . . . . . . . . . .. . . .

TV D .wtPUon

A 0 o Tank 0 of Sump111

or LapoonPit or Pond Cu. Olher

9 Manalaclurer ( d applopnale) Year of Mf g

C Container CapacrI ' gallons ❑ Unknown I E ContwnerRepalrs Elf ,

F Is container curronty uledl

T .Mmn1 .

nknown ❑ 113 Yes Year

u, Yit ❑ w No II No year of Iasi Uae ❑ w Unknown

G Does the Container Store (Check One) fu. Waste ❑ erPtodwc l

Does the Container Store Motor Vehicle Fuet or waste Oil? C .' Ye>a 0a : No If Yea . Check appropriate boa(rs )

V Container COOItnIC On

A Thickness. of Primary C•antIinment _ C Gauge jo lncnec ❑ cm 0 Unknown

g ❑ oI Vault ed (1-Meted in an unoerpround Val1II-

Non-vautled ❑ w Unknow n

C ❑ vi Oouote walled it oa Slnow Walled ❑ u bred 0 a Wrapped ❑ a. Unknown ❑ a None

G ❑ or Carotin Steel ❑ a Sue,rwess SIeT Cl .) F .Deyptass ❑ L. PNyvlnyl Chloride 'a Concrete Elm Alurnnum

E ❑ 1- RuD6al United ❑ wAwyd urmr>q C w EpoxyL mvv Q . Phenolic L-irwr g

F C • Pdyelhlerlt• . WIep ❑ ,. Crlnuol,. PJLA,* ..t,ur1 -- Q .. UrkiwAn NorK: : . .

C Year Initallea: / +9-I--1-- ❑ U nk nown

HDMSe00106431

A AssocraledPlpirng I, Above Ground a Underground DIoorVaulle e

❑ w Stock inventory ❑ ,,, Tae Dram ❑ w Vapor Sh if t wells :. . . . ❑ N- Sbnr or Inblrumen l

❑ wGround Willer Mon it oring Wells ❑ Presb u

❑ w eiriu r

VIII Chem" Compoddon of Materiels Currently or PrevloualyStored In Underground ConteineraII yud crwchud y6a to IV -H UU U1tl rWi IuU•nruo lu' u qau- .u n

.wr .wy . . . p.nl*v rr ,Clw.whr U .; H,,. l lw Cu..mti=t Y /+ .,, v 'ru .u .o e . .u~ 75 v nr .,w.ti rdw.

U u, 01-/ ; $,e L 7V

1 -Hf. Yl rFLZ i}IfOVN/S ^/ ~tldtr i%Ary l1 Caad1llJ/)

❑ r ❑ a'094t v -/Pro 0 Ch 4 Nrt ld1- L

❑ ~ Oo~

O m

U

❑ u . poi

❑ 0 ❑ 0 2

❑ o. ❑ a

p e. ❑ ar

[3 0. 13 U 2

❑ 01 ❑ U7

❑ D . ❑N

is Container locared on an Agncuuural arm? ❑o res 01-IX IMPORTANTI Read lnslruchonS before signing

This form nab oeen compwred under the penally of po iury aria In IN0 Beal of myknovneaga is slue end cor rec tranking 61eC16o dlleC .al or authorized repr6B6nIGl .Vk or a public agenc y

jUgneture ; Trid lorm must be signed fly 11 . a prlnGpel 616cu1 vt eb .CEN at the level of v.Ce- pr6ard0nl or dy an aut",zed repreaenlahve The representa ti ve

mum o esponsik* for he overall operation of me ICclhly where Int lerlkt .1 O(6iocaled 2) n general partner proprietor, or 31 a principal executi ve ortiCe l

Feed rr.r0.i l .W Hrcw .. .wa . :wY.•

x•.

{arid CMCL lo: Haiarpou9 SubalarlCe Storage Statement Blare Walw Resources Control Board P O Boat 100 . Sacramento , CA 95801 0100

FOR STATE USE ONL Y10 hw,wr.

e Unde/ground Plp.ng 'o Gra oly ❑ Pressure ❑ 01 Suction O o. Unknown

C Piping Repairs Do None .. Unknown Cc,, yes, year of most recent repair

VII Leak Delecllo n

W .. Eyr-nr.a 0u,

A. ivr . ..y M+i.nn ci.r.r lane..

Lou

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