BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMEN o00 East Main Street, Stockton, CA 95202-302> Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Fa/ ty NaAIO Th C- D v 11% 7-U (� Iv -0 , Page 2—of Facility Address: City: Ins�ction Dade: 61 Jr 0 EA #: PR #: Program Element: 2 g 3 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum >_ 1320 gallons in tanks and containers over 55 gallons. Com Tete one box for each tank or each cumulative container product type. ❑ Tank (2820) &Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and <250 gallons) 1 2 3�D Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 (>250 gallons) (>55 gallons and <250 gallons) Product Type: Ljj/j f ��Total Capacity: AO DO gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and <250 gallons) 3 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and <250 gallons) 4 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and <250 gallons) 5 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) Total Capacity this Page: Z gallons Total Capacity for Site: gallons Comments: EHD Inspector: Reviewed Date: By Initial:1 Entered Date: By Initial: �/ �—/ r . 1, '0 EHD 28-01 01/16/08