BILLING - 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: _ - d � C Page of � Facility Address* rC� City. O Inspe B O FA#: 6 PR A: Progra EIeTT�� Pig 1 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum ?1,320 gallons in tanks`and containers". Complete one box for each tank or each cumulative container product type, Tank (2820) EIContainers (2821) #of Containers: �- TA#: 1 Product Type: frAl; Total Capacity: 5" gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: C(:)-R gallons Total Capacity for Site: gallons Comments: EHD Inspector: .. Reviewedw' Date: Entered Date: �- By Initial: VA q'41(II By Initial: ,rt `Aboveground storage tank means a tank that has the capacity to store 55 gallons or more 61 petroleum. OC "Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08