Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> v ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,CA 95202-302'9 ' <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 /> a L r�T �l✓ CJ Page _ o` <br /> Facility Address: City: Inspectiop ate: <br /> FA#: PR#: Progrrrajmm Ele ent: <br /> o�0a n -3 <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum >_1320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product <br /> Bank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> I Product Type: of L <br /> Total Capacity: 6 090 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ank (2820) ❑ Containers (2821) #of Containers: TAM 6) :j J 70o7D <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 LD o o D Product Type: Lv 13 C ry G <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: /9?T/ 7 602Q <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: <br /> Total Capacity: Z--,50 e d gallons <br /> (peter tank or cumulative for containers by product type) Install Date: <br /> LN'Tank (2820) ❑ Containers (2821) #of Containers: TA#: /9SJ 7D�02 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: L✓Bmf <br /> Total Capacity: '2-6J 0 D gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> g/fank (2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) T�k <br /> 5 Product Type: //.��((// <br /> Total Capacity: 'z-o 104 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: 0 C7O 6 gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: Entered DateQ: � <br /> C By Initial: By Initial: U <br /> EHD 28-01 <br /> 01/16/08 <br />