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SA OAQUIN LOCAL HEALTH D TRICT <br /> UNDMUND STORAGE TANK PROGRAM fARM TANK INFOON FORM <br /> FACILITY/BITE INFORMATION (Coeplete this Fon for each FARM TANK location) S Z <br /> FARM or BUSINESS NAME CONTACT NAME <br /> F BARTON RANCH, A CALIFORNIA CORP . MR. BRENT R. BARTON <br /> A <br /> C ADDRESS (Street address of TANK location) PHONE 1 WITH AREA coo■ <br /> L 17250 E. Milgeo (209) 869-1812 <br /> l <br /> T CITY STATE 11P CODE NEAREST CROSS STREET <br /> Y Ripon Ca 95366 Murphy <br /> (HECK HERE if this ADDRESS should be used for Legal Notification <br /> OPERATOR INFORMATION i ADDRESS (Complete if In(orsation Different frog Above) <br /> NAME OPERATOR CONTACT NAME <br /> 0 BARTON RANCH, A CALIFORNIA CORP . Mr. Brent R. Barton <br /> P <br /> E MAILING or STREET ADDRESS OPERATOR PHONE 1 WITH ARCA CODE <br /> R 2.2398 S. McBride (209) 869-1812 <br /> A <br /> T <br /> 0 CITY STATE IIP CODE <br /> R Escalon Ca 95320 <br /> X CHECK HERE if this ADDRESS should be used for Legal Notification <br /> PROPERTY OWNER INFORMATION & ADDRESS (Coeplete if Different frog Above) <br /> NAME OWNER CONTACT NAME <br /> 0 MAILING or STREET ADDRESS OWNER PHONE 1 WITH AREA CODE <br /> W <br /> N <br /> E <br /> R CITY S1ATE 11P CODE <br /> CHECK HERE if this ADDRESS should be used for Legal Notification <br /> Chert Appropriate box <br /> T ACTIVE FARM TANK SITE (One or wre underground TANKS ) 1,100 gal. capacity) <br /> Y <br /> P EXEMPT FARM TANK SITE (ALL underground TANKS at site to or ( 1,100 gal. capacity) <br /> E <br /> PERMANENTLY CLOSED FARM TANK SITE (ALL underground TANKS at site revved or closed in place) <br /> UNDERGROUND TANK INFORKATMIN (List Addifional tank inforeation onceparate sheet if needed) <br /> T TANK SIZE 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 , 000 Diesel 4/31/89 Removal 5/9/89 <br /> N 1, 000 Diesel " <br /> 0 1 , 000 Diesel " <br /> 700 Gasoline " <br /> THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT <br /> NAME � TITLE DATEBrent R. Barton � - w <br /> Manager/ 6/26/F39 <br /> OFFICE USE ONLY <br /> SWEEPS 1 COMP 1 LOC CODE DIST CODE11 ACTIVE UGT 1 EXEMPT UGT 1 CLOSED UGT SWEEPS PRGM/SUB CODE DATE <br /> EH 23 044 (12/88) <br />