Laserfiche WebLink
- 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.orgichd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: VAN/ D/5 �O !/. f5 � _ /NL Page�Of <br /> Facility Address: lCity (� /'//I Inspection Date: <br /> FA#: PR#: Program Element: <br /> 1333 <br /> Tank/Container Information <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 /> ET"Tank(2820) ❑ Containers (2821) #of Containers: TA#:.l�5/-7 ,�9oz� <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: d, <br /> Total Capacity: ZP 0s0 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 /> 2 Product Type: <br /> Total Capacity: /22-•-0 gallons <br /> (per lank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) PrIcontainers (2821) #of Containers: z r TAM 70ato <br /> (>250 gallons) (>55aPaJl ons and<250 gallons) <br /> 3 37 Product Type: <br /> Total Capacity: ,-'�gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ..rc(2820) ❑ Containers (2821) #of Containers: TAM <br /> d0 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: _ <br /> Total Capacity: _gallons <br /> (per tank or cumulativ- " oy product type) Install Date: <br /> tank(2820) ❑ Containers (2821) #of Containers: _ TAM <br /> (>250 gallons) (>55 gallons and<150 gallons) _ <br /> 5 Product Type <br /> Total Capacity: 7 illons <br /> (per tank or cumulative for i_..mu.ers by product type) Install Date: <br /> Total Capacity this Pagt q-7 gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> } By Initial: By Initial: <br /> EHD 28-01 D <br /> 01/16/08 <br />