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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton,-CA 95202-3029 Telephone: (209)468-3420 Fax.(209)468-3433 Web:www.sjgov.org/ehd ' Y ' I� ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM E Facility Name: j N7 t1 r 4: M011�1� G .Page—/—of Facility Address: City: Inspection Date: � Orr-re— 14 —'l 3—/L7. FA#: PR#: Program Element. �S3 0 Zg g o Tank/Container Information Complete-for all sites with cumulative aboveground storage of.petroleum 21,320 gallons in tanks`and containers". Complete one box for each tank or each cumulative container product t e. 9/Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Total Capacity: 1500 _ gallons Product Type: (per tank or cumulative for containers by product type) Install Date: t drank (2820) ❑ Containers (2821) #of Containers: TA#: 2Product Type: Tota! Capacity: gyp.© gallons (per tank or cumulative for containers by product type) Install Dater — LS/Tank (2820) 13 Containers (2821) #of Containers: TA#: 3 Product Type: Total Capacity: _: �b gallons (per tank or cumulative for containers by produci type) Install Date: . EJ' #of Containers: TA#:Tank {2820) El {2821) . 4 Product Type: A--F Total Capacity: d gallons (per tank or cumulative for containers byproduct type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: - Total Capacity this Page: �^7 gallons Total Capacity for Site: C7 ;,gallons Comments: I f EHp Inspector: Reviewed �J Date: Entered Date: By Initial: VANL•ld By Initial: A/ 1, 3` 'Abovegr nd storage tank means a tank that has the capacity to store 55 gallons or more of pe roleum. :Container means a storage device designed to be moved when full. 108 AST SURVEY FORM 0911911 2/D8 /