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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENI <br /> '-IK0 East Main Street,Stockton,CA 95202-30200'0 <br /> Telephone.(209)468-3420 Fax.(209)468-3433 Web.www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: Page of <br /> Facility Address: City: Inspection Date: <br /> 'L1 `I 338 Fol✓TANA Ve rK - � - o <br /> FA N: PR#: Program E(gmP O <br /> D o&7 <br /> z OVV <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21320 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#: <br /> (>250 gallons) (>55 gallons and<250 gallons) e <br /> I Product Type: �(O�pJ� <br /> Total Capacity: / O b 0 gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> El Tank(2820) I�Containers(2821) #of Containers: TAM <br /> 2 l <br /> (>250 gallons) (>55 gallons and<250 gallons) Product Type: <br /> e: / CA,r-A O ` L <br /> _ <br /> Total Capacity: �gallons <br /> (per tank or cumulative for containers by product type) Install Date: _ <br /> ❑ Tank(2820) ❑ Containers (282 1) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers(2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: <br /> Total Capacity: gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: O sr gallons Total Capacity for Site: &J-1— gallons <br /> Comments: <br /> 20 (ria 00/f <br /> EHD inspector: Reviewed Dace: Entered Dat <br /> By Initial: (AM By Initial: <br /> EHD 2"1 <br /> 011W08 <br />