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:AN JOAQUIN COUNTY PUBLIC :HEALTH SERVICES <br /> 4+/^ RS s , <br /> UltiDERGRCUND STORAGE TANK PROGRAM - FARM TANK INFO;ZvAT104 FORM <br /> FACILITY/SITE INFORMATION (Complete this Farm for each faciiity/site) DEC Q 3 1992 <br /> LARM or BUSINESS NAME (CONTACT NAME <br /> I PERMtT�SERV�GQ9�' <br /> Jahn Narducci Della Narducci <br /> jI 4DDRESS (Street address of TANK location) HONE # WITH AREA CODE <br /> 4 11945 Murphy Rd (209) 462.4931 <br /> � I,Y TATE IP CODE EAREST CROSS STREET <br /> 77—Stockton CA 9520E) Dodds Road <br /> HECK HERE if this ADDRESS should be used for Legal Notification <br /> OPERATOR INFORMATION & ADDRESS (Complete if Information Different from Above) <br /> 4AME <br /> PERATOR CONTACT NAME <br /> 'AIL3NG or STREET ADDRESS ].OPERATOR PHONE # WITH AREA CODE <br /> STY TATE �IP CODE <br /> HECK HERE if this ADDRESS should be used for Legal Notification <br /> PROPERTY MNE;Z INFORMATION & ADDRESS (Complete if Different from Above) <br /> �JAMEWNER CONTACT NAME <br /> Sc`llTie <br /> 7 4AILING or STREET INFORMATION 3WNER PHONE # WITH AREA CODE <br /> ITY TATE LIP CGDE —7 <br /> HECK HERE if this ADDRESS should be used for Legal Notification <br /> Check Appropriate Sox <br /> CTIVE FARM TANK SITE (One or more underground TANKS > 1,100 gal. capacity) <br /> X XEMPT FARM TANK SITE (ALL underground TANKS at site = to or < 1,100 gat. capacity) <br /> ERMANENTLY 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 /> TANK SIZE CHEMICALS STORED ST MATED DATE LAST USED MEHTOD OF CLOSURE DATE OF REMOVAL OR <br /> (GALLONS) CURRENTLY OR PREVIOUSLY IF CURRENTLY EMPTY IF PERMANENTLY CLOSED CLOSURE IN PLACE <br /> 500 Gas 1982 removed Nov 25, 1992 <br /> THIS FORM HAS SEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT <br /> TITLE ATE <br /> owner Nov 30, 1992 <br /> OFFICE USE ONLY <br /> SWEEPS 9 CMP # LOC CODE DIST CCOE # ACTIVE UGT # EXPEMT UGT # CLOSED UGT SWEEPS PRGM/SUB CODE DATE <br /> �f <br /> EH 23 044 10/89 <br />