BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY AegMIOi9 ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone:(209) 468-3420 Fax: (209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: M ANwA lQA 1'f Page _� of Facility Address: City: Inspection—Date:, — � � � ��'��' � /" P;770/? FA#: PR#: Program Element: Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 11,320 gallons in tanks*and containers". Complete one box for each tank or each cumulative container product type. Tank (2820) ❑ Contain ers (2821) #of Containers: TA#:_ / 1 Product Type: Total Capacity: 3 o n gallons ` n. ..A&01?�,! (per tank or cumulative for containers by product type) Install Date: Yf ) 9-Tank (2820) ❑ Containers (2821) #of Containers: _ TSA#: \ 2 Product Typel—� �Y/ / Total Capacity: � �� gallons (per tank orcumulative for containersby producttype) Install Date: lty-co=o Q Tank (2820) IR'Containers (2821) #of Containers: �_ TA#: 3 Product Type: — '?,7 Total Capacity: SS gallons (per tank or cumulative for containers by product type) Install Date: i^Pn*^�,cv ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Total Capacity: gallons Product Type: (pertank or cumulative forcontainers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: ,r� gallons Total Capacity for Site: .rr gallons Comments: /C RA A;6- z 44 209 - 159 EHD Inspector. ry lel Reviewed Date: Entered Date: G�� By initial: ((.�•�� By Initial: *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. "Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08