Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEN. <br /> X600 East Main Street,Stockton,CA 95202-30NW <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name` Page / of <br /> 7� u <br /> Facility Addrea : City: Inspectioa Date: D <br /> 76 Doral AV4AILl� - 3 . 0°o <br /> FA#: PR#: Program Element: <br /> 0(0-AD5 $SI 2- 2 Z/O <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: <br /> Total Capacity: SO D gallons Install Date: <br /> (per tank or cumulative for containers by product type) - - - - <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: <br /> Total Capacity: gallons Install Date: <br /> (pet tank or cumulative for containers by product type) — <br /> ❑ Tank(2820) ❑ Containers(2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and 250 gallons) <br /> 3 Product Type: <br /> Total Capacity: gallons <br /> (per lank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers(2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: Sm D gallons Total Capacity for Site: G—p D gallons <br /> Comments: <br /> 13 ZP <br /> EHD Inspectorr Reviewed Date: Entered Date: I <br /> C— By Initial: <br /> EHD 28-01 l\ },Ur� By Initial: q p <br /> 0 <br /> 01/16/08 <br />