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SAN JOAQUIN COUNTY <br /> iNVIRONMENTAL HEALTH DEPARTMENT <br /> 'Tido East Main Street,Stockton,CA 95202-302 <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 /> e /Q CARR LU59CO Page�of <br /> Facility Addresa3 /N� ^� City: J 714- Inspection Date: y� <br /> 88 K �!/y <br /> FA#: v A PR#�� 3 ProgremIement: <br /> b1{ <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 /> CrTank(2820) ❑ Containers (2821) #of Containers: TAM 06-/-74?3Y <br /> (>250 gallons) (>55 gallons and<250 gallons) + <br /> 1 Product Type: <br /> Total Ca acit : 3 ® ® gallons Install Date: <br /> (per tank or cumulative by product type) <br /> Tank(2820) 15 Containers (28 ) #of Containers: TA#: /9 5 (Z CP,15— <br /> ns (>55 gallons and Q50 <br /> 2 Product Type: 6,x S O <br /> Total Capacity: 3.027 gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) n <br /> 3 Product Type: �,��__4// / <br /> Total Capacity: S O b gallons Install Date: <br /> (per tank or cumulative for containers by product type) ry <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: 0,`x`7 &,3 <br /> (>250 gallons) (>55 gallons and<50 gallons) n T <br /> 4 Product Type: ��jC/ <br /> Total Capacity: /o670 gallons Install Date: <br /> (pertank or connotative for containers by product type) <br /> Ca'Tank(2820) ❑ Containers (2821) #of Containers: TA#: !'7[p 3 b <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: S029 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> _ Total Capacity this Page: gallons Total Capacity for Site: Z d gallons <br /> Comments: <br /> EHD Inspector Reviewed Date: .1 Entered Date: <br /> By Initial: By Initial 0 <br /> EHD 28-01 <br /> 01/16/08 <br />