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SAN JOAQUIN COUNTY :NVIRONMENTAL HEALTH DEPARTMEN X000 East Main Street,Stockton,CA 95202-3011pt Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: p Q9 0 YARDS Page�of Facility Address: City: Inepectlo Date: 4 Al- M /�oPj �I �zp�m�l FA#: PR#:- BQ6 program- I V 6833 Tank/Container Information 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. ank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and Q50 ga".ons) � 1 Product Type: Z2� 1 Total Capacity: & O e? gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) E,Containers(2821) #of Containers: TA;=: (>250 gallons) (>55 gallons and<250 gallons) ,- e'- -- 2 Product Type: _ /�SiA .f !� D Total Capacity: .5.� 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) 3 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Dat':: ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAM (>250 gallons) (>55 gallons and<50 gallons) 4 Product Type: Total Capacity: gallor.a (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 5 Product'fyp-: _ Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons I Total Capacity for Site: Q gallons Comments: < 13 � / 0 � EHD inspector. Reviewed Date: ,/ Entered Date. By Initial: i1-arjN�6 By initial: EHD 28-01 01/16/08