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I unaergrouna storage ianKrrogram - rarm ianKintormation rurns <br /> FA ILITVSITE INFORMATION (L..plete this form for each FARM TANK loctwon.) <br /> FARM or BUSINESS NAME CONTACT NAME <br /> r <br /> A c . Y A — 2 I. <br /> C ADDRESS(Street address of TANK location) PHONE# (with area code) <br /> I <br /> L <br /> I CITY STATE I ZIP CODE I NEAREST CROSS STREET <br /> Y CHECK 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 /> E Mp^-..- - ------ )l area code) <br /> R <br /> A EgRARI FAR MQ PH. 200-887-3905 209-887-3363 6632 <br /> T Cl7 T` 17071 E. BAKER RD. <br /> O INC. LINDEN, CALIF. 95235 a /�r3 <br /> 7 7 11-2 /580 <br /> I21ael <br /> R / <br /> PAY To TH $ 9Q- o <br /> PROPS ORDER <br /> Of <br /> NA , "��+ —/vO�C) DOLLARS <br /> O STOCKTON MAIN OFFICE <br /> WELLS FARGO BANK <br /> NMP 303 NORTH EL DORADO STREET,STOCKTON.CA 9520! iCode) <br /> E <br /> MfMO - <br /> R cn 1: 1210002481: 632 0560 03340911 <br /> CHECK HERE if this ADDRESS should be used for Legal Notification <br /> CHECK APPROPRIATE BOX <br /> .I. ACTIVE FARM TANK SITE (One or more underground TANKS > 1,100 gallon capacity) <br /> Y <br /> P EXEMPT FARM TANK SITE (ALL underground TANKS at site = to or < 1,100 gallon capacity) <br /> E PERMANENTLY CLOSED FARM TANK SITE (ALL underground TANKS at site removed or closed in place) <br /> UNDERGROUND TANK INFORMATION (List additional tank information on separate sheet if needed.) <br /> T TANK SIZE CHEMICALS STORED ESTIMATED DATE LAST USED METHOD OF CLOSURE DATE OF REMOVAL OR <br /> A (GALLONS) CURRENTLY OR PREVIOUSLY IF CURRENTLY EMPTY IF PERMANENTLY CLOSED CLOSURE IN PLACE <br /> N ' <br /> K <br /> 1 <br /> N <br /> F <br /> O <br /> THIS FORM HAS BEEN COMPL D UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. <br /> NAME TITLE CR.. .. DATE pk- <br /> j <br /> OFFICE USE ONLY <br /> SWEEPS COMP# LOC CODE DIST CODE#ACTIVE UGT #FJCEMPT UGT III CLOSED UGT SWEEPS PRGMSUB CODE DATE <br /> EH 23 044(12/88) <br />