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SAN JOAQUIN COUNTY <br /> �. ENVIRONMENTAL HEALTH DEPARTME <br /> 600 East Main Street,Stockton,CA 95202-3* <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 /> �r )9 p S Page / of <br /> Facility Address: City: Insp yon Da <br /> S J5 C— AI2.%10-4 WAY, STK 07-4W <br /> FA#: PRM - Program Elegtept: <br /> 0 o 0 3 9 B <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 /> Co Tete one box for each tank or each cumulative container product <br /> (2820) Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: t5;' / G ^ fIQG. S <br /> Total Capacity: 2 O& gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank(2820) ontainers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> � Product Type: <br /> Total Capacity: 2 b d gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ontainers(2821) #of Containers: IPI Tei#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: <br /> Total Capacity: lil-d'n gallons <br /> (per tank or emulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<50 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 (282 1) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons Install Date: <br /> (per tank or cumulative for containers by product type) --- <br /> Total Capacity this Page: ae gallons Total Capacity for Site: gallons <br /> Comments: <br /> 152,0 <br /> .V A C, 7Y P€ <br /> EHD[nspector: Reviewed Date: Entered Date. <br /> By Initial: By Initial: <br /> EHD 2M 1 <br /> 01/16/08 <br />