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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEN' <br /> `x'600 East Main Street,Stockton,CA 95202-301r, <br /> Telephone.(209)468-3420 Fax.(209)468-3433 Web.www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> FAdd <br /> e: <br /> PANGZ( Tr/'J (C ) <br /> ess: <br /> Page-__L of_t <br /> ` r • /'�/�f/ <br /> Ci <br /> ty: Inspectioq Dale: r, <br /> J 1� t TL PR#. /ZI Od <br /> 3010-1 OS ? Program Element: <br /> 2g3�i <br /> Tank/Container Information <br /> for all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. <br /> achcumulative containank (2820) ontainers (2821) #of Containers: q gallons) (>55 gallons and<250 gallons) T'4#i �h J o '{Product Type: � lL rCapacity: allons <br /> nk or cumulativejor,,_�contl!iners by product type) Install Date: <br /> ❑ Tank (2820) L9'Containers (2821) #of Containers: TA#: B <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2Product Type: ty d% <br /> Total Capacity: �� gallons � _ L <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) 19tontainers (2821) #of Containers: TA#: Q,rLf��(9, <br /> (>250 gallons) (>55 gallons and<250 gallons) / <br /> 3 Product Type: <br /> Total Capacity: //-A gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> El Tank (2820) L'TContainers (2821) #of Containers: TA#: b512q 9�O <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 �—� 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: TA#: B b le <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: /y Of O ® gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons I Total Capacity for Site: gallons <br /> Comments: P fi <br /> EHD Inspector: �J Reviewed Date: J Entered Date: <br /> By Initial: {•� •l 21' 2 By Initial: VP <br /> $ �� <br /> EHD 28-01 <br /> 01/16/08 <br />