BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY 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: 49 / © d �C (4.51 G t/ (,ji//v Page of Facility Address: City: Inspecti n Date 2 5A I/-I/- Z S- - AI r> ( 4 fv- m G A a 3 ° FA#: _ R#: Progr m Element: �r =r 3 -Z-.94-0 Tank/Container Information Complete r all sites with cumulative aboveground storage of petroleum ?1,320 gallons in tanks'and containers". Com fete one box for each tank or each cumulative container product type. Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Product Type: ,A'V Total Capacity: � �J '� gallons T.� (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM 3 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Total Capacity: gallons Product Type: (per tank or cumulative for containers by producttype) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by producttype) Install Date: Total Capacity this Page: `j gallons Total Capacity for Site: v gallons Comments: 3 Zo i9 d/v EHD Inspector: / Reviewed Date: Entered Date: By Initial: y.�, By Initial: (O '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