BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY 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: l �r MA TOS Page of L_ Facility Address: City: Inspec D te: S" Ar✓T r / o�j FA#: PR#: Progra�QE egtent: 6 o D53 o C 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, LS Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Product Type: Total Capacity: _ _ �e�s gallons �(pe/r tank or cumulative for confiners by product type) Install Date: (J Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Total Capacity: f SD gallons Product Type: AAs (per tank or cumulative for containers by product type) Install Date: El Tank (2820) P/ Containers (2821) #of Containers: TAM 3 Total Capacity: gallons Product Type: _��/0 o/- 0! C/ (per tank or cumulative for containers by product type) �/ Install Date: El Tank (2820) Lf!Containers (2821) #of Containers: TA#: 4B/r/�sSl-r— Total Capacity: SS gallons Product Type: l (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) . ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: p (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: Q 11 gallons Total Capacity for Site: 7o gallons Comments: /Z Nl F- 1�7A rrop - �o ✓ EHD Inspector: �r Reviewed Date: Entered Date: "9 By Initial: I�•�•Q� By Initial: p fq `Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. "Container means a storage device designed to be moved when full. EHD 2&01 09/12/08 AST SURVEY FORM