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Underground Stogy: Tank Program - Farm Tan: ,Xormation Form <br /> FACILITY/SITE INFORMATION (Complete this form for each FARM TANK location.) <br /> F FARM or BUSINESS NAME CONTACT NAME <br /> A Scott Ranch Kent Scott <br /> C ADDRESS(Street address of TANK location) PHONE# (with area code) <br /> I <br /> L 18401 N. Atkins RD. 209-727-5243 <br /> 1 CITY P.O. Box 476, STATE I ZIPCODE I NEAREST CROSS STREET <br /> T Lockeford, CA. CA. 95237 Brandt & Atkins <br /> Y I X I CHECK HERE if this ADDRESS should be used for Legal Notification <br /> OPERATOR INFORMATION&ADDRESS (Complete if information different from above.) <br /> 0 NAME OPERATOR CONTACT NAME <br /> P <br /> E MAILING or STREET ADDRESS OPERATOR PHONE# (with area code) <br /> R <br /> A - — - -- <br /> T CITY STATE ZIP CODE <br /> O <br /> R 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 /> 0 <br /> N MAILING or STREET ADDRESS OWNER PHONE#(with area code) <br /> E <br /> R CITY STATE I ZIP CODE <br /> CHECK HERE if this ADDRESS should be used for Legal Notification <br /> CHECK APPROPRIATE BOX <br /> .l. 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 X 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 DATEOF REMOVAL OR <br /> A (GALLONS) CURRENTLY OR PREVIOUSLY IF CURRENTLY EMPTY IF PERMANENTLY CLOSED CLOSURE IN PLACE <br /> N <br /> K Jim Tborpe Oil Co. , P.O. Box 357. Lodi, .95241 . ph.368-6' 75 <br /> 1 removed both `as tanks 14Dnday June 26, 15,89, filled the holes <br /> N with dirt and hauled the tanks away. The furnished the dr.r ice. <br /> F <br /> O 800 as reviousi June 1 1 8 H <br /> THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. <br /> NAME m TITLE Pres. DATE 7/3/89 <br /> OFFICE USE ONLY <br /> �(1 SWEEPS# COMP# IOC CODE.I DIST CODEJ#ACTIVE UGf #EXEMPT UGT #CLOSED UGT SWEEPS PRGMISUB CODE DATE, <br /> VV EH 23 044(12J88) <br />