BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY 0 j 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: 111D/4-/-'z-- _ _ / ,- 1L�1��rL �7 L/ �/✓ Page of Facility Address: Ins ��it pecti n Da LC,�� 7 2, a FA#: Progyam l me0: Tank/Container Information 3 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. Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Total Capacity: L) ()D gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ank (2820) ElContainers (2821) #of Containers: T�#: 2 Total Capacity: -S'O O d gallons Product Type: ID�� c (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Product Type: 4 !�7j c7 Total Capacity: gallons —c (per tank or cumulative foroontainers by product type) Install Date: El Tank (2820) M'Containers (2821) #of Containers: 4Product Type: /l;OTOS/ Total Capacity: 41 6W gallons (per tank or cumulative for containers by product type) Install Date: ank (2820) ❑ Containers (2821) #of Containers: TA#: 5Product Type: Total Capacity: -34-0 gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: r'(? S'S�V gallons Total Capacity for Site: o r gallons Comments: / r- - 6- EHD Inspector: m r� Reviewed Date: Entered Date: C.i By Initial: VA '1.�.('Q� By Initial: /// *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleu . "Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08