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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 ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: Aim UC-- Page t of 2 Facility Address: V City: Inspec�tlon Dat�� FA#• PR#: Program Element: Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 2,1,320 gallons in tanks*and containers**. Complete one box for each tank or each cumulative container product type. Tank (2820) ❑ Containers (2821) #of Containers: TA#: 65,20/0624 1 Total Capacity: 15� gallons Product Type: �i ��.1, (per tank or cumulative for containers by product type) Install Date: ) '7 t ��u t Tank (2820) ❑ Containers (2821) #of Containers: TA#: aE202j4z3 _ 2 Product Type: Total Capacity: ��gallons (per tank or cumulative for wntalby product type) Install Date: [Tank (2820) ❑ Containers (2821) #of Containers: TA#: aha Dw/v to 3 Product Type: j 0) irk Total Capacity: �-C gallons (per tank or cumulative forwnte nems by product type) Install Date: &Tank (2820) ❑ Containers (2821) #of Containers: TA#: B5 �OLQ w7 4 Total Capacity: �lsb gallons Product Type: A[ASPA 3 (per tank or cumulative for containers by product type) (455 Install Date: Tank (2820) 13Containers (2821) #of Containers: TA 5 Total Capacity: �(J gallons Product Type: I�/>�.� - f, J ppo (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: ogallons Total Capacity for Site: U gallons Comments: EHD Ins e o Reviewed�//� Date: rp Entered Date: By Initial: 1\U� e° (S I13 By Initial: *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. **Container means a storage device designed to be moved when full. EHD 28-01 09/12/08 AST SURVEY FORM