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Underground Storage Tank Program - Farm Ta Information Form , <br /> FACILITY/S1'1'E INFORMATION (44-Implete this form for each FARM 1 ANK locau+)n.) <br /> F FARM or I3USINE:SS NAME <br /> CONTACT NAME <br /> A Browns Lake Ranch Paul McManis <br /> C- ADDRESS(Street address of TANK location) <br /> I PHONE# (with area code) <br /> L 18700E. River Road 209-599-6145 ; " <br /> I CI E1' STATE 'LIP CODE Nr-,ARFS'f CROSS STREET <br /> T Ripon CA 95366 Wagner <br /> Y Cl IECK HERE if this ADDRESS should he used for Legal Notification <br /> OPERATOR INFORMATION&ADDRESS (Complete if information different from above.) <br /> O NAML OPERATOR CONTACT NAME <br /> P Tri M Farms Ron McManis <br /> E MAILING or STREET ADDRESS <br /> R OPERATOR PHONE# (with area code) <br /> ,A 339 Industrial Avenue 209-599-6145 <br /> T <br /> CITY STATE ZIP CODE <br /> O Ripon CA 95366 <br /> R Cl II'sCK F1ERE it this ADDRESS should he used for Legal Notification. <br /> 1'ROI'14,R'rY OWNER INFORMATION&ADDRESS (Complete if different from above.) <br /> NAME OWNER CONTACT NAME <br /> O Paul McManis Paul McManis <br /> NMAILING or STKEEI'ADUKPSS OWNER PHONE#(with area code) <br /> E Industrial Avenue 209-599-6145 <br /> R CFFY STATE; 'LIP CODE <br /> Ripon CA 95366 <br /> CI IECK IIIRIs if this ADDRESS should he used for Legal Notification <br /> CIIECK APPROPRIATE BOX <br /> .I ACTIVE FARM TANK SITE (One or more underground TANKS > 1,100 gallon capacity) <br /> Y <br /> p NA EXEMPT FARM TANK SITE; (ALL underground TANKS at site = to or < 1,100 gallon capacity) <br /> ENA 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 /> TTANK SIZE CIIEMICAIS STORED ESTIMATED DAT!".I-AST USED METHOD OF CLOSURE DATE OF REMOVAL OR <br /> A (GALLONS) CURREN'f1..Y OR PREVIOUSLY IF CIIRRFKI'I,Y EMPTY IF PERMANENTLY CLOSED CLOSURE IN PLACE <br /> N <br /> K <br /> -HAVE-41EIVER HAD AN Irl"DER ;R011413 TANKI <br /> N <br /> F <br /> O <br /> l'IIiS f nRM IIAS 1tIiGN�COMPI,G7TD UNDER PENALTY OF PER.Il1RY,AND TO' III,HIST OF MY KNOWLEDCF„IS TRITE AND CORRF,CT. <br /> NAMI? "`i z� _.____`_____ I'ITLI? Mana er DATE 10/01/89 <br /> OFFICE,USE'ONLY <br /> SWlil'sl,S# COMP# LOC CODIi DIS'I'CODI; #AC"I'IVIi 11G'I' #l:X1iMP'I'U(r"I' #CLOSED IJCil' SWEEPS PRGM/SUI3CODE DATE. <br /> 1;1123 044(12/88) <br />