Laserfiche WebLink
t - SAN JOAQUIN COUNTY M <br /> ENVIRONMENTAL HEALTH DriPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> ` - Telephone: (209)468-3420 Fax: (209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: _ r <br /> S j a ,�K7 � j/X r .37 T 1q TI d /V Page _L_ of <br /> Facility Address: r � ,. City: Inspection Date. <br /> © - i+�l�R�J T/ / or//7 C�, <br /> FA#: PR M h Program Element: , <br /> 1 �9`7V <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 2:1,320 gallons in tanks"and containers"". <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank (2820) ❑ Containers (2821) #of Containers: I TA#: <br /> 1p <br /> Total Capacity: � d Product Type:gallons _ --- <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 2 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 3 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 4 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: S 0-6 gallons Total Capacity for Site: �' gallons <br /> Comments: <br /> P; Z,o / or✓ s <br /> EHD Inspector: =By <br /> viewed Date: Entered Date: <br /> Initial: �,d� By Initial: <br /> "Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. <br /> "Container means a storage device designed to be moved when full. <br /> EHD 28-01 AST SURVEY FORM <br /> 09/12/08 <br />