Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> %w0oENViR0NMENTAL HEALTH DEPARTMEN'Sd <br /> 600 East Maize Street, Stockton,CA 95202-3029 <br /> #,k: Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: /j fCj Page --L of <br /> r-K f <br /> City: <br /> 6 Inspection D e: <br /> Facility Address: QN-0 10rF '�7� <br /> 0 r • Progn� <br /> FA#: PR#: <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum ?1320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. <br /> VTank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) D <br /> 1 Product Type: <br /> Total Capacity: 2. U d gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> l�'Iank(2820) ❑ Containers (2821) #of Containers: TA <br /> 0250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: <br /> Total Capacity: reD gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> Tank(2820) ❑ Containers (2821) #of Containers: ____c TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: <br /> Total Capacity: 2. © gallons Install Date: <br /> (per tank or cumulative Ybr containers by product type) <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAW: <br /> 0250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: <br /> Total Capacity: gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> 1 <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAW: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: 110 gallons Total Capacity for Site: f 0 gallons <br /> Comments: <br /> t <br /> I <br /> EHD Inspector: Reviewed ! Date: Entered Date: <br /> ✓ By Initial: S�ml t ,(3 By initial: 1( <br /> EHD 28-01 <br /> 01/16/08 <br />