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SAN JOAQUIN LOCAL HEALTH DISTRICT RE: Parcel 11242-020-10-5 <br /> N RRU , ORA H F T <br /> FACILITYISITE 109MATION (Coeplett thle ore for each FARM TANK location) <br /> FARM or BUSINESS NAME CONTACT NAME <br /> f! EMERALD HOMES, an Arizona Partnership Sam Vanderpool, Vice President <br /> A <br /> C ADDRESS (Street address of TANK location) PHONE 1 %'T% AAKA COOK P <br /> L Alleged address 25465 S. Tracy Blvd. (415) 828-9100 <br /> T CITY Trac STATE 11P CODE NEAREST CROSS STREET <br /> Y y' CA 95376 Corral Hollow NOV 2 8 <br /> CNECA NEA[ if this ADDRESS should be used for Legal Notification P FNTq <br /> OPERATOR INFORMATION i ADDRESS (Cotplete if Inforeation Different trot Above) <br /> NAME OPERATOR CONTACT NAME <br /> I <br /> 0� <br /> P. <br /> E MAILING or STREET ADDRESS OPERATOR PHONE 1 NITN ARCA CODE <br /> RI <br /> A <br /> T' <br /> O'CITY STATE 11P CODE <br /> kj <br /> I CNECE NE11 if this ADDRESS should be used for Legal Notification <br /> PROPERTY OWNER INFORMATION N ADDRESS (Coeplete if Different Eros Above) <br /> NAME EMERALD HOMES, an Arizona Partnership LINER CONTACT NAME <br /> P.O. Box 2516, Dublin, CA 94568 Sam Vanderpool, Vice President <br /> VAILING or STREET ADDRESS OWNER PHONE I NIT% ARCA CODE <br /> V <br /> N 6375 Clark Avenue (415) 828-9100 <br /> E <br /> CODE <br /> RICITY Dublin, S1111CA 2194568 <br /> x CNEC[ HERE if this ADDRESS should be used lot Legal Notificatio0 <br /> CNacl 11prolriate box <br /> T ACTIVE FARM TANK SITE (Dne or tore underground TANKS > 1,10D gal. capacity) <br /> Y <br /> P <br /> E x EIEMPT FARM TANK SITE (ALL underground TANKS at site • to or C 1,100 gal. capacity) <br /> PERMANENTLY CLOSED FARM TANK SITE (ALL underground TANKS at site revved or closed in place) <br /> UNDERGROUND TANK INFORMATION (List Additional tank inf0ruti0n on se0arate sheet if needed) <br /> 1 TANK SHE 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 /> 1,000 unleaded gasoline 04/21/88 <br /> 1 <br /> 1,000 leaded gasoline 04/21/88 <br /> N <br /> F 500 diesel fuel 04/21/88 <br /> 0 <br /> THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND 10 THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT <br /> NAME TITLE DATE <br /> 4e 4�1 lVice President, Consti. 11/16 8 <br /> OFFICE WE ONLY <br /> SWEEPS 1 COMP 1 LOC CODE DIST CODE11 ACTIVE UGT 1 EXEMPT UGT 1 CLOSED UGT SWEEPS PREM/SUB CODE DATE <br /> 7 <br /> EH 73 044 (12/80) <br />