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SAN JOAQUIN COUNTY <br /> NVIRONMENTAL HEALTH DEPARTMENI `r <br /> 060 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: <br /> CAM � 1=LL SU✓ C,ri� Page—/— <br /> Facility Address: City: Inspection Date: <br /> %p 11VDv5?1"{1AL STK 9524 <br /> FA#: PR©� < Vb3 <br /> Program t� <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum Z 1320 gallons in tanks and containers over 55 gallons. <br /> Co Tete one box for each tank or each cumulative container product type. <br /> ❑ Tank(2820) Containers(2821) #of Containers: TA#: z9, <br /> (>250 gallons) (>55 gallons and<250 gallons) a 5� <br /> 1 �j p Product Type: �alL <br /> Total Capacity: gallons Install Date: <br /> (per tank or cumulative f cotamers by product ntype) J <br /> O250 gallons) (>55 gallons and<25(2821) #of Con <br /> Total gallons Install Date: <br /> per tank or cumulative for containers by product type) r/ <br /> WL <br /> ❑ Tank(2820) 0/Containers(2821) #of Containers: 157� TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 //O pProduct Type: �►�Jc OfI� /. 6 5�� V <br /> Total Capacity: b b r gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> io Pank(2820) ❑ Containers (2821) #of Containers: TA#: % $' <br /> (>250 gallons) 1 (>55 gallons and<250 gallons) r-� - <br /> 4 Product Type: <br /> Total Capacity: S©a gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) Xcontainers (2821) ##of Containers: Z TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: �i e/J e,Q��� cj <br /> Total Capacity: / � � gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: f/20 gallons Total Capacity for Site: ���C. gallons <br /> Comments: <br /> Rot qthA <br /> EHD Inspector Reviewed Date: EntDate: x <br /> B Initial: By Initial: <br /> EHD 28-01 <br /> 01/16/08 <br />