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SAN JOAQUIN COUNTY i 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: R Al C L r < Page_ of Facility Address: City: Inspect n te: r 4- CA EGGo? U1 �!I P FA#: PR#: Program Element: 3 V-D 3 2� y 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. Tank (2820) ❑ Containers (2821) #of Containers: TA#: P6_1 1 Total Capacity: 1 10L 9 ©0 gallons Product Type: 1 7 (per tank or cumulative for containers by product type) Install Date: L i T rAP11 Tank (2820) El Containers (2821) #of Containers: TA#: / 2 Product Type: Total Capacity: '�9-F�®® gallons p, (per tank or cumulative for containers by product type) Install Date: I n I p L(T /�r a rj k LS Tank (2820) ❑ Containers (2821) #of Containers: TA#: /9s1 q eAlr) 3 Product Type: Total Capacity: 10004 gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 85190 cZ I 4 Total Capacity: f Q O00gallons Product Type: (per tank orcumulative forcontainers by product type) Install Date: T oo, 7f�G�T TQC ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: G gallons j Total Capacity for Site: gallons Comments: o/✓ AN6rf//A1// EHD Inspector: By Initiald Date: ^ , OQ Ente al: Date: O 1 p 'Aboveground storage tank means a tank that has the capacity to store 55 gallons or more f p troleum. "Container means a storage device designed to be moved when full. EHD 2801 AST SURVEY FORM 09119/09