BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

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 SURVEY FORM Facility Name: i {rl'I1/� __7.f��' Page of 2 Facility Address: T ,{ City: Ins/pe tion Date: FA#I C' C �� L�t✓`V Ll C r �'J ,�tZ'C�.t —T ZL�/l 0'^s o PR#: Program Element: �F/ C%`�2�1 2 21 3z Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks*and containers". Complete one box for each tank or each cumulative container product type. Elle Tank (2820) YContainers (2821) #of Containers: TA#: "5g4ux o 1 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) E Containers (2821) #of Containers: . TA#: j!!57o2D,2D 2Product Type: lVolt%r o l /�I a� Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: Product Type: p Y� gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: IL; 11'7'5- gallons Comments: EHD In or: Reviewed Date: Entered Date: By Initial: �J� 1.1 Z� k By Initial: "Abov ro storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. "*Container means a storage device designed to be moved when full. EHD 28-01 09/12/08 AST SURVEY FORM