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SAt 7AQUIN LOCAL HEALTH DT - TRICT <br /> UNDERtm. NO STORAGE TANK PROGRAM - FARM TANK INFOfa ,N FORM <br /> FACILITY/BITE INFORMATION (Complete thio Fore for 55each FARM TANK location) <br /> FARM or BUSINESS NAME ea ti0xpp I1 . CONTACT NAME <br /> F BANK OF STOCKTON Stockton, CA 95201 David Chavier <br /> A <br /> C ADDRESS (Street address of TANK location) PHONE 1 WITH AREA COOK <br /> � 848 N. Alpine Road (209) 941-1444 <br /> I <br /> T CITY STATE IIP CODE NEAREST CROSS STREET <br /> Y Stockton CA H 26 <br /> CRECE HERE if this ADDRESS should he used for Legal Notification <br /> OPERATOR INFORMATION i ADDRESS (Complete if Information Different from Above) <br /> NAME OPERATOR CONTACT NAME <br /> 0 <br /> P <br /> E MAILING or STREET ADDRESS OPERATOR PHONE 1 WITH AREA CODE <br /> R <br /> A <br /> T <br /> 0CITY STATE 11P CODE <br /> R <br /> CMECE HERE if this ADDRESS should he used for Legal Notification <br /> PROPERTY OWNER INFORMATION & ADDRESS (Complete if Different from Above) <br /> MAKE OWNER CONTACT NAME <br /> 0 MAILING or STREET ADDRESS OWNER PHONE 1 WIT" AREA CODE <br /> W <br /> N <br /> E <br /> R CITY STATE IIP CODE <br /> CtlfCE tlEAE it this ADDRESS should be used for Legal Notification <br /> CAecl Appropriate Box <br /> T ACTIVE FARM TANK SITE (One or more underground TANKS ) 1,100 gal. capacity) <br /> Y <br /> PEXEMPT FARM TANK SITE (ALL underground TANKS at site R to or ( 1,100 gal. capacity) <br /> E <br /> �( 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 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 1 ,000 gasoline Tank removal 12/26/89 <br /> N <br /> F <br /> 0 <br /> THIS FORM EN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT <br /> NAME TITLE OAT <br /> � <br /> OFFICE BSE ORtl <br /> SWEEPS 1 COMP 1 LOC CODE DIST CODEI! ACTIVE UGT 1 EXEMPT Ufii t CLOSED UGT SWEEPS PRGM/SUB CODE DATE <br /> EH 23 044 (12/88) <br />