BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY QENVIRONMEN`rAL HEALTH DEP w 600 East Main Street, Stockton , CA 95202-3029 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUMSTORAGE PROGRAM SURVEY FORM Facility Name: ',o Page of Facility Address: � city: Sl tns ct n Date: FA ! PR#: Program Element: 1130V Tank/Container Information Complete for al(sites with cumulative aboveground storage of petroleum k1,320 gallons in tanks*and containers". Complete one box for each tank or each cumulative container roduct type. �i Tank (2820) .❑ Containers (2821) #of Containers: TA#: Product Type: ),I _ Total Capacity: gallons l per to or cumulative for containers byproduct type) install Date: �� I I ❑ Tank (2820) Containers (2821). #of Containers: �_ TA#: 2Product T Total Capaeit 5SO alions Type: (per tank o cumulative for containers y product ype Install Date: i ❑ Tank (2820) ElContainers (2821) #of Containers: TAM i 3Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) 'Install Date: + ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) I distal I Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Dat@: Total Capacity this.Page: gallons Total Capac€ty for Site: gallons Comments: l i EMD Inspector: =Reviewed Date: Entered Dat14W — 'L�'�C�ifl By Initial: "'Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. J "Container means a storage device designed to be moved when full. � EHD 28-01 j 09/12/08 AST SURVEY FORM l