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SAN JOAQUIN COUNTY NVIRONMENTAL HEALTH DEPARTMEN" 600 East Main Street, Stockton,CA 95202-3029 Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STO GE PROGRAM SURVEY FORM Facility Name: C Ab TR A NS A-f Page of � Facility Addressyt�B V Inspecti n Date r /U�,l/ ""Cl..vv vJ' FA#: PR#: Program Element: bzo / i�' $ o -2, B 3 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum z 1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. Tank(2820) ❑ Containers (2821) #of Containers: T #: Q5/ 7129 (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: � Total Capacity: 2-.o OB gallons Install Date: (per tank or cumulative for containers by product type) r` ❑ Tank (2820) Containers (2 1 ntainem�=TA#:�`C- r-SR1 (>250 gallons) (>55 gallons an 5Q�aN Q � / 2 Product Type: 11 � �� 6- 0 r V Total Cwt • gallons (per-3�or cumulative for containers by product type) Install Date: ❑ Tank(2820) Lid-Containers (282 1) #of Containers: �� TA#: D5-1 70'11 (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: r2l L) Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) C�ontalnqrs L118, 1 (>250 gallons) (>55 gallons J Cx 4 - Product Type: EArz, Vk L/ Total Ca i . ,5,� gallons Install Date: or cumulative for containers by product type) Tank (2820) acontainers (2821) #of Containers: TA#: b� (>250 gallons) (>55 gallons and<250 gallons) 5 -,200 Product Type: 0 Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 2- �`J 25 gallons Total Capacity for Site: 2G�6D gallons Comments: S� of EHD Inspector: Reviewed Date: �,/ TBy ntered Dat . / By Initial: I.1tJ F,-p."o Initial: D� EHD 28-01 01/16/08