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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street., Stockton, CA 95202-3029 Telephone;(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY-FORM Facility Name: ZLLA Page_Z_of Facility Address: City: Inse ian te: 0- U d l/tr� p'J�Zt (� FA Al: J PR M Program Element: D o �3b ��3T yr Z, g 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 ty pe- , de ank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Total Capacity: .gallons Product Type: (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) Instal! Date: ❑;Tank (2820) ❑ Containers (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 Product Type: Total Capacity: gallons . (per tank or cumulative for containers by product type) Instal! Date: ElTank (2820) ElContainers (2821) #of Containers: TA#: 5 Total Ca acit Product Type: p y: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: gallons .� Comments: EHD Inspector: Reviewed Date: Entered Date: By Initial: By Initial: *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleu "Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08