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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.orglehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> Elk Horn Country Club Page 1 of 1 <br /> Facility Address: City: Inspection daft: [,���' <br /> 1080 Elk Horn Drive Stockton J� ' �� 122, 2atO <br /> FA tt: PR*: i Program Element: <br /> FA0001103 0835484 2831 `x° <br /> Tank/Container 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 /> #of Containers: TA* /0, <br /> Q Tank (28211) F-1 Containers (2821) f 9 <br /> Product Type: diesel <br /> 1 Total Capacity: 520 gallons YP <br /> (per tank or cumulative for conialners by product type) Install Date: Unknown <br /> X❑ Tank (2820) ❑ Containers (2821) #of Containers. TA#: z251!a g 1 ! <br /> diesel (C <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: Unknown } <br /> ��-- #of Containers: 5 TA#: <br /> Tank (2820) Q Containers(2821) <br /> 3 275 Prod <br /> Total Capacity: <br /> Ballow-(per tank or t umulali�f crustarrte s by product type) Install ate: July 22, <br /> ❑ Tank (2820) Q Containers (2821) #of Containers: 2 TAS: <br /> 4Product Type: hydraulic oil �/ ' ) 14 Cfaf oil <br /> 110 .- <br /> Total Capacity: gallons 1� ) <br /> (per lank or cumulative for containers by product type) Install Date: Unknown <br /> a <br /> ❑ Tank (2820) Q Containers (2821) #of Containers: 2 TA#: J�f <br /> 5 Total Capacity: gallons 110 Product Type: used oil <br /> (per tank or cumulative for containers by product type) Install Date: Unknown <br /> Total Capacity this Page: 1, 1 5 gallons Total Capacity for Site: 1, Ilom <br /> Comments: <br /> Facility manager stated the five diesel 55-gallon drums were placed on site on July 22, 2010 <br /> temporarily. Please be aware at the present total capacity (cited above), the facility shall be placed <br /> into the San Joaquin County Aboveground storage tank (AST) inventory, and the facility will be <br /> responsible for complying with the Aboveground Petroleum Storage Act(APSA) and Spill Prevention <br /> Control, and Countermeasure (SPCC) Rule, and for any applicable permit fees. The facility is <br /> responsible for notifying and providing evidence if the total capacity is reduced back to 1,320 gallon <br /> or less. A copy of this survey is sent to you retroactiv lyt- the original survey in July. <br /> EHl7I pe r, Reviewed Date: Intered bate. <br /> By Initial �;q., y Initial: l i <br /> OFAby#Wund storageeans a tank that has the capacity to store 55 gallons or more of petr I m. f <br /> "Container means a sjedevice designed to be moved when full <br /> EMD 28-01 REV 06/03110 AST SURVEY FORM <br />