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OPP 186-2 <br /> APPENDIX <br /> REMEDIAL ACTION CERTIFICATION FORM <br /> (Please type or print in black ink, only) <br /> Instructions for completion on reverse. <br /> 1. Site Name and . 091ation: (street Address, County, City, and <br /> Assessor's parcel number. ) <br /> Lik Cor orat' <br /> 1856 Field Avenue,VSan JoaQUin Countv,_Stackton. CA <br /> Parcel No 133-390-03 A. List any other names that have been used to identif sites: <br /> Lika Field Field Avenue nnex <br /> B. Address of site if different from above: <br /> C. Assessor's Parcel Numbers: _133-390-03 <br /> 2. Responsible Parties (Use extra pages if necessary.) <br /> Name: TANny Corooration Name: <br /> Title: Title: <br /> Firm: Firm: <br /> Address: 1900 Taylor Street Address: <br /> City: Ft. worth TX City: <br /> Zip: 76102 Zip: <br /> Telephone: (S17) _390-3700 Telephone: ( ) <br /> Relationship to site: (Such as generator, hauler, etc. ) <br /> Current Landowner/operator .Parentcomnanv of leaseholder <br /> -1- September 1987 <br /> C <br /> �M/900d MOMEON 01 'V TH 1Y] I KIM WOH WYO6 Z0 £O-£Z-60 <br />