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f <br /> x Underground Ste le Tank Program - Farm Tan�.formatlon Form <br /> r <br /> FACILITY/SITE INFORMATION(Complete this form for each FARM TANK location.) <br /> FAR44 or BUSINESS NAME CONTACT NAME <br /> A ABF Farm Services Inc. William W. Salmon <br /> C ADDRESS(Street address of TANK location) PHONE# (with area code) <br /> I 7761 W. Undine Road (209) 462-0208 <br /> L <br /> I CITY STATE I ZIP CODE NEAREST CROSS STREET <br /> T Stockton CA 95206 Howard Road <br /> Y C14ECK HERE if this ADDRESS should be used for Legal Notification <br /> OPERATOR INFORMATION&ADDRESS (Complete If information different from above.) <br /> O NAME OPERATOR CONTACT NAME <br /> P <br /> -MAILINjG!nr-STREETADDRESS-- - _,- ,-, -OPFP.ATOR-PHONE-# (witb of f, t ds) <br /> A <br /> T : CITY STATE ZIP CODE <br /> O <br /> R CHECK HERE is this ADDRESS should be used for Legal Notification. <br /> PROPERTY OWNER INFORMATION&ADDRESS (Complete if different from above.) <br /> NAME OWNER CONTACT NAME <br /> O <br /> N MAILING or STREET ADDRESS OWNER PHONE#(with area code) <br /> E <br /> R CITY STATE I ZIP CODE <br /> CHECK HERE if this ADDRESS should be used for Legal Notification <br /> CHECK APPROPRIATE BOX <br /> T ACTIVE FARM TANK SITE (One or more underground TANKS > 1,100 gallon capacity) <br /> '. Y <br /> EXEMPT FARM TANK SITE (ALL underground TANKS at site to or < 1,100 gallon capacity) <br /> XX PERMANENTLY CLOSED FARM TANK SITE (ALL underground TANKS at site removed or closed in place)x <br /> UNDERGROUND TANK INFORMATION(List additional tank information on separate sheet If needed.) <br /> T TANK SIZE CHEMICALS STORED ESTIMATED DATE LAST USED MErI'LtOD OF CLOSURE DATE OF REMOVAL,OR <br /> A (GALLONS) CURRENTLY OR PREVIOUSLY IF CURRENTLY EMPTY IF PERMANENTLY CLOSED CLOSURE IN PLACE <br /> N Pulled out tarok with. <br /> K 2000 Regular Gas dan., ,11987 backhoe-backfilled it Feb. 1987 <br /> I <br /> N <br /> F <br /> O <br /> THIS FORM)JAS BE COMPLETED UN ERP A TY F PERJURY,AND TO THE BEST OF MY KNOWLEDGE,iS TRUE AND CQRRF.CT- <br /> NAME TITLE DATE , <br /> OFFICE USE ONLY <br /> SWEEPS# COMPO LOC CODE I DIST CODE10 ACTIVE UGT #EXEMPT UGT #CLOSED UGT SWEEPS PRGMISUE CODE DATE <br /> Ell 23 044(121M) <br />