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' Underground Storage Tank Program - Farm Tank Information corm <br /> 'FACILITYAIITE INFORMATION (Complete this form for each FARM'rANK location.) <br /> F FARM or BUSINESS NAME CONTACTNAMB �. <br /> A Charles R, Alcock <br /> C ADDRESS(Street address of TANK location) PI-IONE A (with arca code) <br /> I <br /> L 5971 W Linne Rd. (209) 835-1919 <br /> I CITY STATE ZIP CODE NEAILFSTCROSS S1'RGET <br /> T Tracy CA 95376 Banta Rd. <br /> Y <br /> XX7 CHECK HERE if this ADDRESS should be used for Legal Notification <br /> OPERATOR INFORMATION &ADDRESS (Complete if information different from above.) <br /> 0 NAME OPERATORCONTACTNAME <br /> P <br /> E MAILING or STREET ADDRESS OPERATOR PHONE 0 (with area code) <br /> R <br /> A <br /> T CITY STATE ZIP CODE <br /> 0 <br /> R CHECK HERE is this ADDRESS should be used for Lcgal Notification. <br /> PROPERTY OWNER INFORMATION&ADDRESS (Complete if different from above.) <br /> NAME OWNER CONTACT NAME <br /> 0 <br /> NMAILING or STR=— ADDRESS OWNER PHONE U(with area code) <br /> E <br /> R CITY STATE ZIP CODE <br /> CHECK HERE 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 XX EXEMPT FARM TANK SITE (ALL underground TANKS at site. = to or < 1,100 gallon capacity) <br /> B 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 VST USED METHOD OF CLOSURE DATE OF REMOVAL OR <br /> A (GALLONS) CURRFNTLYORPREVIOUSLY IFCURREM'LYEMPTY IF PERMANENTLY CLOSED CLOSURE IN PLACE <br /> N <br /> K 4000 Dies¢l April 1989 —Mar 8 198 <br /> I 330 Unleaded Gas <br /> N 550 Unleaded Cas <br /> F <br /> 0 <br /> TUTS FORM IIAS ZrNCOMJLCTED UNDERPENALTY FPERTURY,AND TO THE IIFST OF MY KNOWLr:DCY,IS TRUE AND CORRECT. <br /> NAME II v 17TLE <br /> orF[cc USE ONLY Owner DATE 5268 <br /> SWEEPSq COMPO IOCCODE D.ISTCODE NACTIVEUG"f IIEXEMPTUGT NCLOSEDUGT SWEEPSPROM/SUECODE DATE <br />