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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 /> Acampo Ag Service (Manna Ranch Inc.) Page 1 of 2 <br /> Facility Address: City: Inspection Date: <br /> 775 E. Acampo Rd. Acampo Sep 1, 2011 <br /> FA#: PR#: _ Program Element: <br /> 9713 ` A :72- b 1 2832 <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum >_1,320 gallons in tanks'and containers". <br /> Complete one box for each tank or each cumulative container product type. <br /> XJ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 14,000 Product Type: <br /> dyed diesel <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: unknown <br /> ❑X Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 2Total Capacity: 4,000 gallons Product Type: dyed diesel Tp�Q$ I (,44b <br /> (per tank or cumulative for containers by product type) Install Date: unknown <br /> X❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM <br /> 3 Total Capacity: gallons <br /> 2,000 Product Type: dyed diesel TA#5 i 6tigt <br /> (per tank or cumulative for containers by product type) Install Date: unknown <br /> ❑X Tank (2820) ❑ Containers (2821) #of Containers: TA#: B,6-dzOr3'lp <br /> 4Product Type: diesel <br /> Total Capacity: 1,000 gallons <br /> (per tank or cumulative for containers by product type) Install Date: unknown <br /> ❑X Tank (2820) ❑ Containers (2821) #of Containers: TA#: rT jp /93 7 'z <br /> 5 1,000 Product Type: 87 octane gasoline <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: unknown <br /> Total Capacity this Page: 12,000 gallons Total Capacity for Site: 12,570 gallons <br /> Comments: <br /> While on site to conduct a HW inspection, AST's were observed. <br /> EHD Inspector: C Reviewed Date:c/ n Entered Dat <br /> 1' By Initial: ��'yt. - J L �,i By Initial: I <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 REV 06/03110 AST SURVEY FORD <br />