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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 lof 2 <br /> Facility Address: City: Inspection Date: <br /> 525 Acacia St., Stockton 2/2_/2011 <br /> FAN' 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 /> ® Tank (2820) %Containers (2821) #of Containers: <br /> 1 Total Capacity: gallons 55 Product Type: hydraulic oil <br /> (per tank or cumulative for containers by product type) Install Date: <br /> a Tank (2820) Containers (2821) *of Containers: 2 TA#: AxTji./JL <br /> 2 110 Product Type: used oil <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 3 Product Type: <br /> Total Capacity: gallons <br /> (per lank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 4 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) <br /> #of Containers: TA#: <br /> 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: 165 gallons Total Capacity for Site: 10,765 gallons <br /> Comments: <br /> The used oil containers are in hazardous waste area, and the used hydraulic oil container in the old <br /> power plant. <br /> EHD Inspector. Reviewed Date: ` Entered Date: <br /> By Initial: p`(, 2 20 (( By Initial: <br /> 'Aboveground storage tank means a tank that has the capacity to st re 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 />