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- ----------------- <br /> Underground <br /> -Underground Sto 1. Tank Program - Farm Tan' ormation Form <br /> FACILITY/SITE INFORMATION (Complete this form for each FARM TANK location.) <br /> F FARM or BUSINESS NAME CONTACT NAME <br /> A P d, S Farms James E . Podesta <br /> C ADDRESS(Street address of TANK location) PHONE# (with alta code) <br /> I <br /> L _ <br /> I CITY STATEFIZ3 <br /> IP CODE NEAREST CROSS STREET 1ad41PIMIlE:N'f <br /> T Stockton CA205Beecher Rd . RECE`IV:ED <br /> Y CHECK HERE if this ADDRESS should be used for Legal Notification <br /> OPERATOR INFORMATION&ADDRESS (Complete if information different from abov . <br /> 0 NAME OPERATOR CO �NIAF1E tc <br /> P rnie Podesta or §jarlmaornd <br /> E MAILING or STREET ADDRESS OPERATOR PHONE# (with arm code) <br /> R <br /> A __ __ _ <br /> T CITY STATE ZIP CODE <br /> O <br /> R I CHECK HERE is this ADDRESS should be used for Legal Notification. <br /> PROPERTY OWNER INFORMATION &ADDRESS (Complete if different from above.) <br /> NAME OWNER CONTACT NAME <br /> O James E . Podesta Ernie Podesta <br /> NMAILING or STREET ADDRESS OWNER PHONE#(with area code) <br /> E 12123 E . Comstock Rd . 209-931-2756 <br /> R CITY STATE I ZIP CODE <br /> Stockton Ca 95205 <br /> X I CHECK HERE if this ADDRESS should be used for Legal Notification <br /> CHECK APPROPRIATE BOX <br /> .I. ACTIVE FARM TANK SITE (One or more underground TANKS > 1,100 gallon capacity) <br /> Y <br /> P EXEMPT FARM TANK SITE (ALL underground TANKS at site = to or < 1,100 gallon capacity) <br /> E PERMANEN'MY 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 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 CIASUREINPLACE <br /> N farm—diesel fuel <br /> K 4000 5/89 removal 5/89 <br /> I <br /> N <br /> F <br /> O <br /> THIS FOR <br /> AS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND COR <br /> NAME _ TITLE DATE �Zl <br /> OFFICE ONLY <br /> S WEEPS# OOMP# I LOC CODE DIST CODEJ#ACTIVE DOT #EXEMPT UGT #CLOSED UGT S WEEPS PRGMiSUB CODE DATE <br /> EH 23 044(12/88) <br />