BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY NVIRONMENTAL HEALTH DEPARTMENT _ '00 East Main Street,Stockton,CA 95202-3029 Telephone:(209)468-3420 Fac:(209)468-3433 Web:www.sjgov.org/ehd ' ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: Page_L Of Facility Address: City: Inspection D te: I // z 610 FA#: PR#: Program Element: 17067 1 0 at? a�- 8� 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. PT'Tank (2820) ❑ Containers (2821) #of Containers: TA# (>250 gallons) (>55 gallons and<250 gallons) nn 1Product Type: Total Capacity: .-o a gallons Install Date: (per tank or cumulative fm containers by product type) ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAM (>250 gallons) (>55 gallons and<250 gallons) 2 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank(2820) ❑ Containers(2821) #of Containers: TA#: (>250 gallons) (>55 gallons and Q50 gallons) 3 Product Type: Total Capacity: gallons Install Date: (per tank m emulative for containers by product type) ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and Q50 gallons) 5 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) Total Capacity this Page: '5-00 gallons I Total Capacity for Site: Szps gallons Comments: EHD Inspector: Reviewed I Date: Entered Date: By Initial: a-(_ By Initial: O)ri EHD 28-01 01/16/08