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• • SAN JOAQUIN COUNTY • ENVIRONMENTALHEALTH 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: S F rbc ( $ Page Of Facility Address: /� City: Inspection Date: FA M: GKrvr LA�c. PR M: 7� Z--lO Program Element: ©0l6 2 �z-7 l,7 Tank/Container Information � 31 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 ro . ct type. �I Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 e: Total Capacity: �'O Product Type:yp �5w' LIC (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) Q-Containers (2821) #of Containers: _ / TA#: z9,5-)1(p,li—I 2 Total y�Ca acit Product Type: A _ T-r Capacity: 55" gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ,RContainers (2821) #of Containers: 1_ TA#: N5 I 3 Total Capacity: gallons Product Type: o;J containers(per tank or cumulative for cby product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Total Capacity: gallons Product Type: (per tank or cumulative for mmaamers by product type) Install Date: ❑ 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: gallons Total Capacity for site: 3 I ry gallons Comments: EHD Inspector: Reviewed Date: Entered Date: (,3(, By Initial: By Initial: 'A veground storage tank means a tank that has the capacity to store 55 gallons or more o petroleum. "Container means a storage device designed to be moved when full. EHD 28-01 09(72108 AST SURVEY FORM