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` SAN JOAQUIN COUNTY NVIRONMENTAL 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: KJR S-C 1VM f1j 5� Page —/— of-,L— FacilityAddress: City: Inspection ate: 13 / 44- c- Iv �L S S G �" ^ L a FA#: PR#: Progr lemen : D 1 06-3049402 g 30 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. M Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1Product Type: Total Capacity: � � gallons (per tank or cumulative for containers by product type) Install Date: V Tank (2820) ❑ Containers (2821) #of Containers: TA#: 09,5) �s8`d3 2Product Type: �r r Total Capacity: v--t) gallons (per tank or cumulative for containers by product type) Install Date: i /Tank (2820) ❑ Containers (2821) #of Containers: 'TA#: 3 Product Type: Total Capacity: gallons (per tank or cumulative for containers by Product type) Install Date: ElTank (2820) L'7 Containers (2821) #of Containers: �_ TA#: a-5-) 4 Product Type: �/f�-Sl� G►s � Total Capacity: � gallons (per tank or cumulative for containers by product type) Install Date: P'Tank (2820) ❑ Containers (2821) #of Containers: TA#: D`5-1 gf4S� Cp 5 Total Capacity: SG gallons Product Type: i -A (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: gallons Comments: EHD Inspector: Reviewed Date: Entered Date: By Initial: V�" �.�1-Q� By Initial: hlil *Aboveground 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 AST SURVEY FORM 09/12/08