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SAN JOAQUIN COUNTY <br /> �r ENVIRONMENTAL HEALTH DEPARTME- J <br /> 600 East Main Street, Stockton,CA 95202-3"L9 <br /> Telephone.(209)468-3420 Fax.(209)468-3433 Web.www.sigov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> SO D SS' f AV W' Page of <br /> Facility Address: (TL PR <br /> IoPeq /o/ / / / &� /\ / CityA �/ a/ / �, Q F /FA#: #: Program Element: <br /> DQO S <br /> 283 <br /> Tank/Container reformation <br /> Complete for all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. <br /> link(2820) ❑ Containers (2821) #of Containers: TA#: 7 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> I Product Type: � J <br /> Total Capacity: 3 2a o gallons <br /> (pa tack or cumulative for containers by product type) Install Date: <br /> link(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: <br /> Total Capacity: Ov gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank (2820) ❑ Containers(2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: 0 gallons Total Capacity for Site: 741-0d gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: / Entered Date: <br /> ` By Initial 5,•'pb By Initial: <br /> ECD 28-01 <br /> 01/16/08 <br />