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�./ 'w/ 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: T A/J U(-I0T Page Of Facility Address: City: InspectiD e: / y7 6 P. 7 0 FA#: PR K:D Program EI menta Egg TtD65DI Z B Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum ?1,320 gallons in tanks' and containers". Complete one box for each tank or each cumulative container product type. & ank (2820) ❑ Containers (2821) #of Containers: f� TAM 1 Product Type: Total Capacity: SCz�L gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) Montainers (2821) #of Containers: ,� TA#: 2 Total Capacity: Z 3-75 gallons Product Type: (per tank or cumulative for containers by product type) Install Date: El Tank (2820) Ly'Cont nets (2821) #of Containers: TA#: 3 Total Capacity: S gallons Product Type: /�! 19 IL-- (per tank or cumulative for contalners by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product 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: gallons Total Capacity for Site: Q gallons Comments: EHD Inspector: „r Reviewed Date: Entered Date: L By Initial: >J ) --o-Cel 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. EMD 28-01 AST SURVEY FORM 09/12/08