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JIM. THORPE. OIL. INC 209 368 1851 ptglyE <br /> P. 0SANAQUIN LOCAL HEALTH DI9iOCT <br /> UNDEA60 No VORME TANK PROGRAM • FAR Ijl ANK INFOR04110 fORM 'VVvt <br /> FACILITYr81YE AFORNAnoN (Complete this Fore for each FARN TANK location) ___.___ _-lAN S)1_1999 <br /> FARM or OUB(NESi NAME CONTACT NAME <br /> F JOHN S. 13; 4[N ENVIRONMENTAL HEALTH <br /> !t' ADDRESS (Street address of TANK location) PHONE 1 "'T" AAeA coo. <br /> .l <br /> L Zl6 S- Sc sol St. <br /> CI/Y STALE 11P CODE NEAREST CROSS STREET <br /> t od <br /> CKECE NEVE if this ADDRESS should be used for Legal Notification <br /> OPERATOR INFORK.n110N A ADDRESS (Cospletm it InfocaatloA Different from Above) <br /> ._INANE.._._. OPERATOR CONTACT NAME <br /> ti <br /> ;(MAILING or SIREIT ADDRESS OPERATOR PHONE A "II" AO&A Aooc <br /> r licitY SPATE IIP CODE <br /> 4 LNFCI NEVE if this ADDRESS should be used for legal Notification <br /> PROPERTY OKI INFORMATION b ADDRESS (Complete if Different (roe Above) <br /> OWNER CONTACT NAME <br /> JOHN S BOWEN <br /> 'l101AILING or STRV T ADDRESS OWNER PHONE 1 """ AAaA CYO[ <br /> I� <br /> "; 3592 W Sargent Rd. (209) 368-3001 <br /> b1TY Lodi , , A 95242 STATE IIP CODE <br /> CNECA NEAE 1 this ADDRESS should be used for Legal Notification <br /> Check ApprefriaPr Say <br /> j <br /> ART TANK SITE lone or more underground TANKS ) 1,100 gal. capacity) <br /> EMPr FAROTARKSIT[ (ALL underground TANKS at site " to or ( 1,100 gal. capacity)RMAHEMttY CLOSED 1�TANK 51TE (ALL underground TANKS at site removed a closed in places _» <br /> UNDERGROUND TAV INFORMATION (List Additional tank information on separate sheet if needed) <br /> r TANK SIZE CHEMICALS STORED ESTIMATED DATE LAST USED METHOD OF CLOSURE DATE OF REMOVAL OR <br /> F (GALLO115) CURRENTLY OR PREVIOUSLY IF CURRENTLY EMPTY IF PERMANENTLY CLOSED CLOSURE IN PLACE <br /> Solvent prior to 1980 filled with sand/ _ — <br /> Solvent -filled w sand tank removed = <br /> THIS FORM NA DEIN COMPLETED UNDER PENALTY Of PERJURY, AND i0 THE BEST OF MY KN0YLE06E, 18 TRUE AND CORRECT — <br /> H'NE <br /> DATE <br /> Dec 11 , 1998 <br /> tFF1rE Nt NEr <br /> f ;uEFPS ! COMP t� LOC COGE DIST CODE / ACTIVE U6111 EIEMPT UGT 1 CLOSED Ufii SWEEPS PRGH/SUD CODE DATE r <br /> 2) 0{4 (12188) <br />