Laserfiche WebLink
Underground Storage Tank Program - Farm Tap), Information form ` <br /> FACILITY/SITE;INFORMATION (k-omplete this form for each FARM TANK location.) <br /> TC M or BUSINESS NAME <br /> CONTACT NAME <br /> rowns Lake Ranch Paul McManis <br /> DRESS(Street address of TANK location) <br /> PLIONE H (with area code) <br /> L 18700 E. River Road 209-599-6145 <br /> r. I C1TY <br /> STATE ZIP CODE NEARES'r CROSS STRL'ET J J <br /> T Ripon CA 95366 Wagner <br /> y CIIECK HIRE if this ADDRLSS should he used for Legal Notification <br /> OPERATOR INFORMATION &ADDRESS (Complete if information different from above.) <br /> O NAME <br /> Tri M Farms OPERATOR CONTACT NAME <br /> P Ron McManis <br /> E MAILING or STREET ADDRESS <br /> R OPERATOR PHONE# (with area code) <br /> 'A 339 Industrial Avenue 209-599-6145 <br /> 1 CITY STATE ZIP CODE <br /> O Ripon CA 95366 <br /> R CHECK LIERE is this ADDRESS should be used for Legal Notification. <br /> I'ROPI:R'rY OWNER INFORMATION&ADDRESS (Complete if different from above.) <br /> NAME OWNER CONTACT NAME <br /> O Paul McManis Paul McManis <br /> N MAILING or STREET'ADDRESS OWNER PHONE M(with area code) <br /> E 339 Industrial Avenue 209-599-6145 <br /> R CI'IY STATE 'LII'CODE' <br /> Ripon CA 95366 <br /> CI IECK l IERE if this ADDRESS should be used for Legal Notification <br /> CIIECK APPROPRIATE BOX <br /> .1 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 /> E <br /> NA 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 /> T TANK SIZE CI IEMICAIS STORED GSTIMAT I)DATh I-AST USED ME77iOD 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 /> !!AVE iEVER HAD AN UNPERIROUND TANKI <br /> N <br /> _ F <br /> v <br /> 1'\IN rO-RM IIAS Iti;;N OMPLL-I`ED UNDER PENALTY OF 1'MJURY,AND'I'O'na-IIEST OF MY KNOWLEDGF„IS TRUE AND CORRECT. <br /> a NAME, —���. TITLE Manager DATE 10/01/89 <br /> OFFICE?USE.ONLY <br /> SWI--,EPS a COME'N LOC CODEDIST C0DI; N ACTIVE UCr N EXIiMP'1'UG'1- N CLOSED UGT Swr-.EM PRGM/SU13 CODE DATE <br /> — <br /> H 1 23 044(12/88) <br />