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SAN JOAQUIN COUNTY MIRONMENTAL HEALTH DEPARTMEN `/ 000 East Main Street,Stockton,CA 95202-30r Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: Ak 09 YZA115 YARDS Page of Facility Address: qty: Inspectio Da';: / 9 Al- Al Z,0 4)! /l �2 7 '�$ FA#: PR#: Program EI guneaft 6833 05 eos 2- Tank/Container informatic a Complete for all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. ER/f;nk(2820) ❑ Containers(2821) #of Containers: TA#: (>250 gallons) (>55 gallons and Q50 ga:!ons) — 1 Product Type: Total Capacity: 3 O d gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) Containers (2821) #of Containers: TA:'': (>250 gallons) (>55 gallons and<50 gallons) /• _- Total Capacity: S� gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Tank(2820) ❑ Containers(2821) #of Containers: TA#: ('> 50 gallons) (>55 gallons and<50 gallons) 3 Product Type: Total Capacity: �' ti gallons (per tank or cumulative for containers by product type) Install Da: Tank (2820) 13Containers (2821) #of Containers: TA#: 250 gallons) (>55 gallons and<50 gallons) 4 \ Product Type: y, Total Capacity: //t% galloi.a (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAM (>250 gallons) (>55 gallons and<50 gallons) 5 Product'i ypp: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) Total Capacity this Page: gallons I Total Capacity for Site: Q -7 gallons Comments: EHD Inspector: pr f 1,I,\ Reviewed Date: ,/ Entered Date: Id\. By Initial: 1,JA By Initial: END 28-01 01/16/08