BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

SAN JOAQUQICOUNTY • s�ENvIRONMENTAL HEALTH DEPARTMENI,� 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 SURVEY FORM Facility Name: Page of Facility Address: City: Inspection 7' D L S f G Ooe2 il0lj S T' $ 7`!6 y'//J l✓� FA p: PR H: Program Element: jqqcp2 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) I Product Type: /'17a Total Capacity: -76d 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) 2 Product Type: 0,- Total rTotal Capacity: :?'6 Z3 gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and Q50 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 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) $ Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) Total Capacity this Page: gallons "Total Capacity for Site: OO gallons Comments: ERD Inspector. Reviewed Date: Entered Date: By Initial: �(b.0 By Initial: ERD 28-01 01/16/08