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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> Dameron Hospital Page 1 of 2 <br /> Facility Address: City: Inspection Date: <br /> 525 Acacia St., Stockton 2/23/2011 <br /> FA M PR#: Program Element: <br /> 2864 526379 2832 <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks'and containers". <br /> Complete one box for each tank or each cumulative container product type. <br /> #of Containers: TA#: 0516958 <br /> 0 Tank(2820) [1 Containers (2821) <br /> 1Total Capacity: gallons 10,000 Product Type: dyed diesel <br /> (per tank or cumulative for containers by product type) Install Date: ` <br /> X❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: O S q /1 <br /> 2 � (m ��> 150 Product Type: dyed diesel CAP <br /> otal Capacity: gallons �y/� r <br /> (per tank w cumulative for containers by product type) Install Date: — /--C [ <br /> -t&Wtkdeo' aT'iM <br /> # (7 �A!260 ` <br /> Z Tank (2820) of Containers: TA#:Containers (2821) <br /> 3 %A+Ad Z�SS �j 150 Product Type: dyed diesel 1 <br /> Total Capjc, : gallons <br /> (per tank or cumulative for containers by product type) Install Date: C t ' <br /> ZTank (2820) E] Containers (2821) #of Containers: TA#: 3l t I U <br /> 4 JOIS 4" -':Z>150 Product Type: diesel <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: J <br /> ❑X Tank (2820) ❑ Containers (2821) #of Containers: TA#: Lr2] '� <br /> 5 Total Capacity: gallons <br /> 150 Product Type: diesel <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: 10,600 gallons Total Capacity for Site: I O-f-65- 14,,,§W gallons <br /> Comments: <br /> #2 and 3 are day tanks at new power plant, #4 and 5 are day tanks at old power plant. <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> By Initial: 'l�' I By Initial: �J A <br /> "Aboveground storage tank means a tank that has the capacity to dtore 55 gallons or more of petroleum. <br /> ""Container means a storage device designed to be moved when full. <br /> EHD 28-01 REV 06/03/10 AST SURVEY FORM <br />