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SAN JOAQUIN COUNTY ' �f QENVIRONMENTAL HEALTH DEPARTME' 600 East Main Street, Stockton,CA 95202-3024 Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sj'gov.org/ehd. ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility me: v l� 13 o �KI w /�N (/ Page . of Facility Address: City: Inspecti z o0o i I3r- Rd. LT ' S ~�� FA#: PR#: Program t.1 n coo 979 � Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum �-1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative containerProdgettyndl ank(2820) ❑ Container 21) #0 tai ers: A#' (>250 gallons) (>55 gallons and ) Total Capacity: l s i (per tank or c mers by product type) Install Da e: Li'Tank(2820) ❑ Containers (2821) #of Containers: TA#: 19fiR le4 $ (>250 gallons) (>55 gallons and<250 gallons) 2 Product Type: �LC Total Capacity: 3 o d gallons (per tank or cumulative for containers by product type) Install Date:. Tank(2820) ❑ Containers (2821) #of Containers: TA#: nu (>250 gallons) (>55 gallons and<250 gallons) / 3 Product Type: IWA S4/7 a-�, l Total Capacity: 3 d-6 gallons . (per tank or cumulative for containers by product type) Install Date: El Tank(2820) Containers (2821 ) #of Containers: TA#: le gu" (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: p Total Capacity: S--r gallons (per tank or cumulative for containers by product type) Install Date' Tank(2820) El Containers (� 1) �ontain TA /9 5f fp g (>250 gallons) (>55 gallons and<250 ga 5 o uct Type: _ Total Capacity: (JD. on (per tank or cu ers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: ` gallons Comments: I EHD Inspector: Reviewed Date: Entered Date: By Initial: 13y Initial: EHD 28-01 01/16/08 4.