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SAN JOAQUIN COUNTY NVIRONMENTAL HEALTH DEPARTMENT VO East Main Street,Stockton,CA 95202-3020 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM F.eSt name: z Page--/— of Fa ty City: Inspection D yOZ5, '6, ^A� c) 11 FA f#. PR#: Program Eternent. I ? 7 1 Rsa 2830 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 1Product Type: -DI r-rl'(/ Total Capacity: 5-" gallons (pr tank or cumulative for containers by product type) Install Date: Q,eTank(2820) ❑ Containers(2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 2 /0'* Product Type: ��,EO 17/�,S7; G Total Capacity: � � gallons (per tank or cumulative for containers by product type) Install Date: Yank(2820) ❑ Containers (282 1) #of Containers: TA#: >25 gallons) (>55 gallons and<250 gallons) 3 719: � J Y/1//9 f /L Total Capacity: � � gallons Product Type: (per tank or cmnulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (282 1) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: oC/ gallons Comments: EHD Inspector. Reviewed I Date: Entered Date: By Initial: 1 . nl 11,�•Q By Initial: EHD 28-01 ��WNN" 01/16/08