Laserfiche WebLink
0 SAN JOAQUIN COUNTY 0 IF= <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.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: r <br /> �(J 6 L_L ! � �S Page of <br /> Facility Addres City: Inspec i e: <br /> FA#: PR#: Program Element: <br /> 71 az) ; <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks`and containers". <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: PeeTj <br /> 1 Total Capacity: S O7 gallons Product Type: TE d' `� <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> Q Tank (2820) ❑ Containers (2821) #of Containers: TA*=--D,h17 le <br /> 2 (� ,�� Product Type: �* A 7 <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) <br /> �,/ Install Date: <br /> L7 Tank (2820) ❑ Containers (2821) #of Containers: TA#: /9,5-1 :Z� 7T_ <br /> 3 Product Type: --A S g <br /> Total Capacity: t�1--rsc gallons <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM <br /> 4 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 5 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> By Initial: By Initial: ;/ <br /> "Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. <br /> "Container means a storage device designed to be moved when full. <br /> EHD 28-01 AST SURVEY FORM <br /> 09/12/08 <br />