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SAN JOAQUIN COUNTY &ENVIRONMENTAL HEALTH DEPARTMEN _ 00 East Main Street,Stockton,CA 95202-302 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/eh C % 1 ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY-FORM ; Facility Name: / Lt/ l T T T S C)2T 70N Page of Facili Address: City: Inspecfi o/ ) C. A "- L 7-00/0 FA#: PR#: Program Element: CPO 01z3Q9 5S z1 y6 �' 2- Tank/Container Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. Tank(2820) ❑ Containers (2821) #of Containers: TA#: D.SI !n 1 j90 (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: Total Capacity: 10, C 0@ gallons (per or cumulative for coAtainers by product type) Install Date: Tank(2820) ❑ Containers (2821) #of Containers: T)#: p,S)It 1�[ (>250 gallons) (>55 gallons and<250 gallons) 2 Product Type: Total Capacity: D O L76 gallons (per tank or cumulative for con ' ers by product type) Install Date: Tank(2820) ❑ Containers (2821) #of Containers: TA#: 6 5l it t 0,;2 (>250 gallons) (>55 gallons and<250 gallons) �.., _ /J 3 v 0 ,96 Product Type: /�� Total Capacity: gallons (p tank or cumulative for taints by product type) Install Date: Cd/er Tank(28 Containers (2821) #of Containers: TA#: e '5 (>250 gallons) (>5 and<250 gallons) 4 -7 Product Type: �A S /`4 N T/F!E'�F-� Total Ca acity: 3 ga d� (per r cumulative for containers by product type) Date. Tank(2820) ❑ Containers (2821) #of Containers: TA#:D,SI�[ O y (>250 gallons) dons and<250 gallons) 5 000 Product Type: (J/� Total Capacit Seta � gallons Install Date: (per tank or cumulative 'for =by product type) Total Capacity this Pager �cgallons Total Capacity for Site; � �2 gatlons Comments: W o ERD Inspector: Reviewed D.1e' Entered Uat : j C.� By Initial: By Initial: B EHD 2M I 01/16/08