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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 St IRvt=v Cnoee Facility Name: �. r vINIVI o - r —inPage of / Facility Address: L� _ City:Inspection Date: /Gomc FA 0:2O . __7la3—ta 7 /y- n:7-a0 Progam mimet : � Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 11,320 gallons in tanks' and containers`•. Com fete one box for each tank or each cumulative container Product type. kjTank (2820) ❑ Containers (2821) #of Containers: TAM ©�j/ (o3S l 1 Total Capacity: Product o�� gallons Type: (per tank or cumulative for Tank (2820) product type) Install Date: -7L/ 99,1' ❑ Containers (2821) *of Containers: TA#: j 6" y 2 ` Total Capacity: /000-0 gallons Product Type: )�5� (per tank or cumulative for con finers by product type) Install Date: __7 // �J 9 9 ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Total Capacity: gallons Product Type: _ (per tank or cumulative forcontalnem 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: p gallons Total Capacity for Site: 2,0 ®OO gallons Comments: rr> EHD Inspecto - ' c $ Reviewed Date: _ Entered / q Da , By Initial: Y'� Z By lnitfal: k *AIDo ' round st Daae ank means a tank theat h., .• -------- _� __ � _ •••— —•^r• Ly • atuio ou yauvn5 ur more Or petroleum. / Ir ntainer means a storage device designed to be moved when full. EHD 28-01 08/12/08 AST SURVEY FORM