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SAN J&QUIN LOCAL HEALTH DIS ICT UNDERORTORAGE TANK PROGRAM - FARM TANK INFORMAT�RM FACILITY/BITE INFORMATION (Coeplete this Fon for each FARM TANK location) FARM or BUSINESS NAME CONTACT NAME F Barton Ranch, A California Corp Mr . Brent R. Barton A C ADDRESS (Street address of TANK location) PHONE 1 WITH ARIA coo■ f 122398 S. McBride (209) 869-1812 Y CITY Escalon, S�AaE 219 CODE NEARESLeeSS STREET Rd xx CHECK 111fif if this ADDRESS should be used for Legal Notification OPERATOR INFORMATION i ADDRESS (Coeplete if Inforution Different froe Above) NAME OPERATOR CONTACT NAME O P E MAILING or STREET ADDRESS OPERATOR PHONE 1 WITH AREA CODE R T 0 CITY STATE IIP CODE R CHECX HERE if this ADDRESS should be used for Legal Notification PROPERTY OWNER INFORMATION t, ADDRESS (Coeplete if Different froe Above) NAME OWNER CONTACT NAME 0 MAILING or STREET ADDRESS OWNER PHONE i WITH AREA CODE W N E R CITY STATE IIP CODE CHECK HEAE if this ADDRESS should be used for Legal Notification CAact Appropriate Box Y ACTIVE FARM TANK SITE (One or sore underground TANKS ) 1,100 gal. capacity) P EXEMPT FARM TANK SITE (ALL underground TANKS at site • to or ( 1,100 gal. capacity) E X 1PERMANENTLY CLOSED FARM TANK SITE (ALL underground TANKS at site reeoved or closed in place) UNDERGROUND TANK INFORMATION (List Additional tank inforeetton on sen?rate sheet if needed) T TANK SIZE CHEMICALS STORED ESTIMATED DATE LAST USED METHOD OF CLOSURE DATE OF REMOVAL OR A (GALLONS) CURRENTLY OR PREVIOUSLY If CURRENTLY EMPTY IF PERMANENTLY CLOSED CLOSURE IN PLACE N K 4 , 000 Diesel 4/31/89 Removal 5/9/89 1 2 000 Gasoline " N F 1 , 100 Diesel " 0 1,000 Gasoline " THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT NAME TITLE DATE Brent R. Barton G Manager 6/26/89 OFFICE USE OAIY SWEEPS 1 COMP i LOC CODE DIST CODE11 ACTIVE UGT 1 EXEMPT UGT 1 CLOSED UGT SWEEPS PRGM/SUB CODE I DATE EH 23 044 (12/88)