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ABOVEGROUND PETROLEUM STORAGE TANK <br />FILE COVER SHEET <br />FACILITY ID#: FA0017192 <br />PROGRAM RECORD #: PR0530399 <br />ADDRESS: 20361 N RAY RD <br />FACILITY NAME (DBA): VAN DIEMEN FARMS <br />FACILITY PHONE: (209) 368-3690 0 <br />FACILITY CONTACT: <br />OWNER NAME: VAN DIEMEN FARMS <br />OWNER ADDRESS: 20361 N RAY RD <br />P/E: 2830 <br />P/E: <br />P/E: <br />CITY: LODI <br />FACILITY FAX: <br />PHONE: <br />CITY: LODI <br />PHONE: <br />DATE: 08/14/2009 <br />DATE: <br />DATE: <br />Water Service: <br />❑ Large PWS <br />❑ <br />Small PWS <br />❑ Domestic Well <br />Sewer Service: <br />❑ Public Sewer <br />❑ <br />OnSite WWTX <br />❑ OnSite Septic System <br />Stormwater: <br />❑ Street Drains <br />❑ <br />Street Ditches <br />❑ OnSite Ponds ❑ Other <br />Tank Record ID <br />Tank PE <br />Capacity <br />No of Compartments Additional Description <br />TA0518841 <br />2821 <br />55 <br />1 GAS 87 1 CONTAINER @ 55 GALLONS <br />TA0518842 <br />2820 <br />275 <br />GAS 87 <br />TA0518843 <br />2820 <br />200 <br />GAS 87 <br />TA0518844 <br />2820 <br />1000 <br />DIESEL <br />TA0518845 <br />2821 <br />55 <br />1 WASTE OIL 1 CONTAINER @ 55 GALLONS <br />TA0518846 <br />2820 <br />250 <br />GAS 87 <br />EH 00 18 rev 04/2008 <br />rpt # : APST New Owner: Create a New Cover Sheet / Change Label of File <br />