BILLING - Laserfiche WebLink

Home Browse Search

.' SAN JOAQUIN COUNTY NViRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 �f Telephone: (209) 468-3420 Fax: (209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: �L oG G7-D`✓ / /% 11gr/"0// �`/3 Page �of Facility Address: City: Inspe t (3 3 �a //r_ Al-)D)'/ k ' y To Tom I 17n 7K #: PR#: Proeram_ re.., •- DO FR Tank/Container.fnformation 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 type. Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Product Type: Total Capacity: -F® a _ gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) 11Containers (2821) #of Containers: TA#: 2 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install'Date: l �• ❑ Tank (2820) El Container s (2821) #of Containers: TA#: 3 Total Capacity: gallons Product Type: (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: t (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page- dr gallons Total Capacity for Site: gallons Comments: �R(V1-�v r t E E EHD Inspector: Reviewed Date: ��/ Entered Date: ✓ By Initial: l�°�� o D By Initial: t *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