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SAN JOAQUIN COUNTY <br /> 9NVIRONMENTAL HEALTH DEPARTMENI,.f <br /> "600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone.(209)468-3420 Fax.(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility No <br /> / .S'U N F U 111 l�T C L G Page of <br /> Facility Address: City: Inspection te: <br /> F- 'E 0 U LINT el"r . C• /0/( d <br /> FA#: PR#: Program.Element: <br /> 61 o6 027Lete3 .z <br /> Tank/Container Information <br /> Comple for all sites with cumulative aboveground storage of petroleum ;2:1320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: ?5 / `IA42k <br /> (>250 gallons) (>55 gallons and<250 gallons) Type: fl_ /lp <br /> 1 <br /> Total Capacity: gallons Product T <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: N,,1571 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) P Containers (282 1) #of Containers: TAM 5)6-1.7 A4R_S <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: yLsd 5r,0/2, O'r � <br /> Total Capacity: / Z 9 gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> El Tank (2820) ®'Containers (2821) #of Containers: TA#: P5_1 ?Ai o`Z <br /> 4 <br /> (>250 gallons) (>55 gallons and<250 gallons) i�� A /! O <br /> Product Type: -�/ /V L� <br /> Total Capacity: gallons <br /> (per tank or cumulative for contain by product type) Install Date: <br /> 0 "Tank(2820) ❑ Containers (2821) #of Containers: TAM 06- <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 .r I�- p/ <br /> Product Type: �it//4 <br /> Total Capacity: � S�D gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: 5& gallons Total Capacity for Site: gallons <br /> Comments: <br /> AlAsT .✓ii <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> By Initial: lv ,�eq By Initial: <br /> EHD 28-01 <br /> 01/16/08 <br />