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Underground Storage Tank Program - Farm Tank Information form <br /> 'ACIVATY/SITE INFORMA'T'ION (Complete(Iris form for each FARM'TANK location.) <br /> FARM or BUSINESS NAME CONTACI'NAME <br /> GEORGE PERRY & SON'S, INC. ART <br /> ADDRESS(Street address of'fANK location) 1'IIONE N (with arca code) <br /> I 13979 S. HWY 99 (209) 823-6753 <br /> I CITY S'1'A'1'E 711'CODE NE'AREST CROSS STREET <br /> r MANTECA CA 95336 LATHROP <br /> Y CI11'sCK IIERE if Ihis ADDRESS should be used for legal Notification <br /> ►1'ERATOlt INFORMA'T'ION &ADDRESS (Complete If information different from above.) <br /> NAME OPERATOR CONTACI'NAME . <br /> 1' SAME AS ABOVE <br /> ' MAILING or STREETADDRESS OPERATOR IIIIONG# (with area code) <br /> R <br /> A <br /> l UTY SPATE ZIP CODE, <br /> It CI IE:CK Ill`.RE is this ADDRESS should be used for Legal Notification. <br /> 'ItOPFIVIT OWNER 1NFOItMATION &ADDItESS (Complete if different from above.) <br /> NAME OWNER CONTACT NAME <br /> SAME AS ABOVE <br /> W MAILING or STREET ADDRESS OWNEIt PHONE N(with area code) <br /> N <br /> I; <br /> R CITY STATE 7.11'CODE; <br /> CIIECK 11ERE if this ADDRESS should be used for Legal Notification <br /> 'IIECK APPROPRIATF BOX <br /> I. ACTIVE FARM TANK SPIT (One or more underground TANKS > 1,100 gallon capacity) <br /> Y <br /> I, FAEMI''1'FARM TANK SITH (ALL underground'I'ANKS at site to or < 1,100 gallon capacity) <br /> EPERMANENTLY CLOSED FARM TANK SITE (ALL underground TANKS at site removed or closed in place) <br /> INDERGROUND TANK INFORMATION (List additional tank information on separate sheet If needed.) <br /> E TANK SIZE.? CI IEMICAIS STORED ESTIMATED DATE EAST USED MFTI IOD OF CLOSURE DATE OF REMOVAI.c <br /> A (GALLONS) CURREN'T'LY OR PREVIOUSLY IF(AIRREN'I•l.Y EMP'T'Y IF PERMANENTLY CLOSED CLOSURE 1N PIACI: <br /> N <br /> K 3,000 GAS WK. OF JUNE 19, '89 REMOVED JUNE 19 , 1989 <br /> 1 4,000 DIESEL WK. OF JUNE 19, '89 REMOVED JUNE 19, 1989 <br /> N 12,000 DIESEL WK. OF JUNE 19, '89 REMOVED JUNE 19, 1989 <br /> I� <br /> I IIS FORM IIAS"-EN COMPLETED Il )ER PENALTY OF PERJURY,AND TO' IIF IIEST OF MY KNOWLEDGE,1S TRUE AND CORRECT. <br /> NAME? TITLE VICE-PRESIDENT TREASURER DA1T JULY 21, 1989 <br /> ►FFICE USE,ONLY <br /> ,;WITI'SM (x)MPM IfX:CODI'.1 DIS"CODF MACI'IVillIX;I• MItXliMl''I'U(il' MCLO.SFiDUGf SWlilil'SPRGM/SIIBCODI? UA'II. <br />