Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEN, <br /> East Main Street,Stockton,CA 95202-302V-e <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 /> S ?t 9! lC N - Page 4 of <br /> Facility Address: City: Ins n Do <br /> I�12 EL NA (r ST s Z r°% <br /> FA#: PR#: Program Element: <br /> Tank/Container Information <br /> Complete fora Rites cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product <br /> I_R"Tank(2820) ❑ Containers(2821) #of Containers: TAM (,S/(Q3&Q <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> I Product Type: <br /> Total Capacity: SSS gallons <br /> (per mak or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) Containers (2821) #of Containers: <br /> (>250 gallons) (>55 ga loos and<250 gallons) <br /> Product Type: <br /> Total Capacity: 7--0 6 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) El"Containers(2821) #of Containers: _� TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: �� I�J <br /> Total Capacity: r5- gallons Install Date: <br /> (per tank or cumulative for containers by product type) — <br /> ❑ Tank (2820) Ly'Containers(2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: pin—OX--, <br /> Total Capacity: //O gallons Install Date: <br /> (pa tank or cumulative for containers by product type) -- <br /> ❑ Tank(2820) [12(Containers (2821) #of Containers: L TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: V O gallons Install Date: <br /> (pa tank or cumulative for containers by product type) <br /> Total Capacity this Page: ZLf gallons Total Capacity for Site: 2 Lf gallons <br /> Comments: <br /> L. 2(7 A c.Lor/S <br /> HHD Inspector: Reviewed 1 Dale: _I Entered Date: <br /> C _ By Initial: V,r') fj"�' By Initial: <br /> EHD 2M 1 <br /> 01/16/08 <br />