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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <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 /> Facility Address: �Je ,k Page__ Of <br /> pp 00 city: Inspection Date: <br /> F 7 2�i /O <br /> (�O"71� PRM <br /> Program Element: <br /> g31 <br /> TanklContainer Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks'and containers". <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: zq5/ 7,:Z03 <br /> 1 o Product Type: _. <br /> Total Capacity: /J o gallons <br /> (per tank or cumulative for containers byproduct type) Install Date: <br /> ,E' Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 -7 Q /2�_ <br /> 2 Total Capacity: Soo _gallons Product Type: 9/ �f cra I <br /> (per tank or cumulative for containers by product type) Install Date: <br /> wlfL. �/es <br /> ❑ Tank (2820) P�Containers (2821) #of Containers: I TA#: 'z a O ��- <br /> 3 Total Capacity: SS gallons Product Type: w_ �s}�-- n{ l <br /> (per tank or cumulative for containers by product type) Install Date: <br /> �K Tank (2820) ❑ Containers (2821) #of Containers: TA#: TAO,S/g4e�8 <br /> 4 Total Capacity: Som gallons Product Type: le¢� f�i�� / sn/%f <br /> r <br /> (per tank or cumulative for containers by protluct type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 5 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: Z QCJ s- gallons Total Capacity for Site: �7 Ss gallons <br /> Comments: <br /> EHD Inspector Reviewed Date: Entered Date: <br /> By Initial: ( � By Initial: �1 <br /> ground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. <br /> " ontainer means a storage device designed to be moved when full. <br /> EHD 28-01 <br /> 09/12/08 AST SURVEY FORM <br />