Laserfiche WebLink
• SAN JOAQUIN COUNTY • <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 /> 1 S U'C-' Page _ of 2 <br /> City; Inspeetln Date: <br /> rw <br /> FacilityAddresa: ( � y <br /> FA MPR#: Program Element: <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#: 19/0(0 4 <br /> 1 Product Type: I <br /> Total Capacity: j gallons MCCl2 'UI U <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: Sa©�� <br /> 2 Product Type: <br /> Total Capacity: L gallons ,( 0o <br /> (per tank or cumulative for containersby product type) Install Date: <br /> [Tank (2820) El Containers (2821) #of Containers: TA#: J9hc'20Ly/o�P <br /> 3 � Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for oontainers by product type) Install Date: <br /> �3 Tank (2820) ❑ Containers (2821) #of Containers: TA#: A5,C2&IZZ <br /> 4Product Type: <br /> Total Capacity: ln�e s Af <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) 13 Containers (2821) <br /> #of Containers: TA#: TE <br /> 5 Product Type: Lti <br /> Total Capacity: U gallons - 'N" ' if w Cst <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: -71 q U gallons <br /> Comments: <br /> EHD In e o • Reviewedy/!'�' 1 Date: Entered Date: <br /> By Initial: 4 <br /> 1\V �° (S �(3 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 /> AST SURVEY FORM <br /> EHD 28-01 <br /> nonvrne <br />