BILLING - Laserfiche WebLink

Home Browse Search

i - '^ , SAN JOAQUfN COUNTY -� ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.orglehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: G d L Page of Facility Address: City: Inspectan )6 '11AIVOE IiZ V-/ t , FA#• PR#: Program Element: 67 �.8 . 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 ty2e. Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Product T Total Capacity: _ Z Type. bu d� gallons - --_— (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Product Type: Total Capacity: gallons • •• (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ElContainers (2821) #of Containers: TA#: 3 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Total Capacity: gallons Product Type: (per tank or cumulative For containers 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: gallonsTotal Capacity for Site: 2--,Q gallons Comments: EHD Inspector: Reviewed Date: Entered Date: . By Initial: 4-1v p% I L I &)/9 By initial: "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 28-01 AST SURVEY FORM 09/12108