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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:OVA �I <br /> G/ Ff C) � �Rl L A A/0 S IN G Page —I/-- of / <br /> Facility Address: City: Inspection o te: <br /> 9/3 2 , - /,I GAM e /i/ o1� <br /> FA#: PR#: Program Element: <br /> 05a�45 2g <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks'and containers". <br /> / <br /> Complete one box for each tank or each cumulative container product type. <br /> E7 Tank (2820) ❑ Containers (2821) #of Containers: TA#: 9,17/ <br /> 1 Total Capacity: /000 gallons Product Type: <br /> (peter tank or cumulative for containers by product type) Install Date: <br /> vTank (2820) ❑ Containers (2821) #of Containers: // T17A#: Z J5)76 'W <br /> 2 Total Capacity: pd gallons Product Type: 6�/OS d 7 <br /> (per tank or cumulative for con ainers by product type) Install Date: <br /> El Tank Container : A#: <br /> B l �5JT9 <br /> Tank (2820) Containers (2821) � <br /> 3 Total Capacity: 100 gallons Product Type: A�T� Q/ G <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) E�Containers (2821) #of Contairters: // GTA#: 1 <br /> 4 Total Capacity: I s g Product Type: - /Y TT <br /> �gallons <br /> (per tank or cumulative for contain <br /> ��ntai ss by product type) Install Date: <br /> ❑ Tank (2820) V4.-ontainers (2821) #of Containers: TA#: <br /> 5Total Capacity: �J gallons Product Type: Z1� <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: 11710 gallons Total Capacity for Site: / '/ 0 gallons <br /> Comments: <br /> EHD Inspector: ` Reviewed � � ` Date: ,/ Entered Date: <br /> r By Initial: vd0 ><�,2-U- By Initial: l(1A( B <br /> .Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. <br /> "Container means a storage device designed to be moved when full. <br /> EHD 28-01 AST SURVEY FORM <br /> 09/12/08 <br />