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SAN JOAQUIN COUNTY Nftd <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: <br /> TOHPJ /ND,1:f6/T Z i it/ Page of <br /> Facility Address: City: Inspection Da : <br /> i373b S, A057-11V /?cam > 2 <br /> FA#: PR#: Pr ra 1 t: <br /> D5 g?pc <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 11,320 gallons in tanks'and containers <br /> Complete one box for each tank or each cumulative container product type. <br /> gr Tank (2820) ❑ Containers (2821) #of Containers: 7-}1#: <br /> 1 Total Capacity: gallons Product Type: y <br /> (per tank or cumulative for WntA product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 2 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 /> 3 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 /> 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: 3 gallons Total Capacity for Site: -3o6 gallons <br /> Comments: <br /> 2, p <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> 6y Initial: wj 11-r(.o`l) By Initial: ILL <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 />