BILLING - Laserfiche WebLink

Home Browse Search

10-11, SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMEIltO� a 600 East Main Street,Stockton,CA 95202-3029 Telephone.(209)468-3420 Fax.(209)468-3433 Web.www.sigov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: TA / V�L[.� S �n/T # f Page of Facility Address: City: Iospecnon D te: z00 =/ ,ST/G a? oP FA#: PR#: Program Element: c] 0 DD 1i 0 TanWContainer Information Complete for all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. Com ete one box for each tank or each cumulative container prochict ❑ Tank(2820) Containers (2821) #of Containers: ) TA#: / 277 4fs ,�j�� (>250 gallons) (>55 gallons and<250 gallons) l Product Type�� — Total Capacity: J St gallons Install Date: (per tank or cumulative for containers by product type) —- — ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAM (>250 gallons) (>55 gallons and<250 gallons) S 2 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons I Total Capaci for Site: gallons Comments: lof � / � �0 �r ALL/oNS - �/✓ p GT/!�� 0T dr- �S �✓� �6E� .� Inspector: Reviewed Date: Entered Date: By Initial: ,) 5,2'6.0 By Initial: 01