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SAN JE )UIN LOCAL HEALTH DIST CT <br /> UNDER6ROUNMORA6E TANK PROGRAM - FARM TANK INFORMATION16M <br /> FACILITUSITE INFORMATION (Cosplete this Fon for each FARM TANK location) <br /> FARM or BUSINESS NAME CONTACT NAME �VV <br /> f Ferguson Farms Inc. - Mr. p <br /> C ADDRESS (Street address of TANK location) PHONE 1 WITH "&A Co"• �9D <br /> I � <br /> L 14333 W. Clifton Court Rd. 209 465-9828 <br /> I <br /> T CITY STATE 11P CODE NEAREST CROSS STREET ti 71 <br /> Y Stockton CA 95206 Tracy Blvd. <br /> CNECI HIRE if this ADDRESS should be used for Legal Notification �' Q <br /> OPERATOR INFORMATION i ADDRESS (Cosplete if Intonation Different eros Above) <br /> NAME OPERATOR CONTACT NAME <br /> 0 <br /> f MAILING or STREET ADDRESS OPERATOR PHONE I WITH A.C. CODE <br /> R <br /> A <br /> T <br /> U CITY STATE 11P CODE <br /> k <br /> CNECC (CIE if this ADDRESS should be used for Legal Notification <br /> PROPERTY OWNER INFORMATION It ADDRESS (Cosplete if Different from Above) <br /> NAME R & M Ranch OWNER CONTACT NAME <br /> Mr. Roba Miert F. Ferguson, Mr. Robert K. Ferguson, <br /> 0 MAILING or STREET ADDRESS OWNER PHONE 1 WITH .•C. C"4i <br /> W <br /> n 7436 Meadow Ave. 209/465-9828 <br /> 1 p pp <br /> R CII CAE 15207E <br /> tockton <br /> R CNECE WERE if this ADDRESS should be used for Legal Notification <br /> Chect IApopiata Bol <br /> 1 ACTIVE FARM TANK SITE (One or more underground TANKS > 1,100 gal. capacity) <br /> Y <br /> P EIEMPT FARM TANK SITE (ALL underground TANKS at site to or ( 1,100 gal. capacity) <br /> E <br /> % PERMANENTLY CLOSED FARM TANK SITE (ALL underground TAkKS at site removed u( clused in place) 1 <br /> UNDERGROUND TANK INFORMATION (List Additional tank information on separate sheet if needed) <br /> T TANK SITE 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 00 Gasoline (Reg. 6/82 Removal 11/84 <br /> 1 <br /> N <br /> F <br /> 0 <br /> THIS FORM HAS BEEN COMP( ED UNDER PENALTY Of PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT <br /> NAME b �k TITLE GATE <br /> Mr. Robert K. er son V.P. Ferguson Farms 15 May 89 <br /> OFFICE USE OILY <br /> SUEEPS i COMP 1 LOC CODE DIST CODE 1 ACTJVE LOT 1 EXEMPT LOT 1 CLOSED 111 SWEEPS PRGM/SUB CODE DATE <br /> EN 23 044 (12/88) <br />