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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 'x-600 East Main Street,Stockton,CA 95202-302"/ <br /> Telephone.(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> TD G -t lu/ Page 1 of <br /> Facility Address: City: Inspection Dat <br /> -Z'C;'o Z 6 L N o Gle--T PW 7 'So lo g <br /> FA#: PR#: Pragm&FLemknt: <br /> OOPL r'4g g <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 /> L <br /> Complete one box for each tank or each cumulative container product <br /> E''1'ank(2820) ❑ Containers(2821) #of Containers.. TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) O <br /> 1 Product Type: <br /> Total Capacity: 940 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> 94 <br /> an/ (2820) ❑ Containers(2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: Ol <br /> Total Capacity: 3 To gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> �ank(2820) ❑ Containers(2821) #of Containers: TAM i <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: lily /�3.�� <br /> Total Capacity: SOy gallons <br /> (per tank or cumulative for containers by product type) Install Date' <br /> ❑ Tank(2820) 9�ontainers(2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<50 gallons) n � <br /> 4 Product Type: n ;� <br /> Total Capacity: in J gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: <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: // s S gallons Total Capacity for. �/ s gallons <br /> Comments: <br /> L l2-0 T <br /> EHD Inspector. Reviewed Date: Entered Date: <br /> C. By Initial: voi . (o By Initial: S <br /> EHD2"1 0 U <br /> 01/16/08 <br />