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- <br /> " �111=.1v1P_L.Cii✓.'�1.TH `�iR�IV!c.iV <br /> 600.past Main Street, Stocktor_, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)468-3433 Web:ti,Pww-sjZay.erJeltti <br /> _V4 7L AN,11 SURVEY <br /> ND <br /> ABOVEGROW <br /> -�'` ,��+ Page � of <br /> Facility tiame: ! C!' q, ! -rO�✓ �� l•�G��/1/ /l/� � <br /> City: l+ Inspection Date: <br /> Facility,address: ; >�� /V <br /> Q - lr v.F/PR#: Program 1—en- } <br /> Tank/Container 111formation <br /> Complete for all sites with cumulate e aboveground <br /> for�achstrlc or pet olezrtul um 213tive ontairoer predns in nict type and containers over 56 gallorls. <br /> Can. 1 <br /> Cl Tank (2520) Containers (2821) #of Containers: TA : <br /> (>250 gallons) t>55 gallons and<250 gallons) <br /> 1 product Type: <br /> Tota gallons <br /> 1 Capacity: y rodu� e Install Date: <br /> (pe.;mk or cumulative for contain�xs b p w ) <br /> r <br /> 1 <br /> r 7 ) Itof ContailAGrs: _ y <br /> Tank {?g�0, Containers (2521) _ TAS-. <br /> <250 g,l,c:s; <br /> 2 r— Product Type: �f IV ��� +f <br /> I <br /> Total Capacity: gallon!] <br /> }stall Date: <br /> (per kink or cuanulative for containers by product type) <br /> �D_ Tank (2820) Containers (2821) sof Containers: �� Tyr . I <br /> (>250 gallons) (>55 gallons and<250 gallons) /r ff ' <br /> Product T` i"�'�� � <br /> i otdi Capacity: gallons Y-_:iJ��azl <br /> l <br /> er tank or cumulative for conta:ncrs by product type) t <br /> i Y <br /> / r <br /> '-1`,5C na3lors) (%55 gallons and<250 gallons`, ,.7 <br /> d <br /> l V ,,:Ct T y p,e.SIX f4 <br /> _v <br /> Cun n <br /> _cit•'_ �Lcos'�j lx aiLi n <br /> .5 ,GU j rut=L oP--a <br /> ]Cx�: 1r/' <br /> 50 =dons; (>55 liens zinc<250 g�Ilons) <br /> nt ., .St1'-�l-,.l• ..r LSV'....id::...�" 7Cf.':.�-. ,1:'_, _ - ___ —. _.- ._ .--__r._.. .....F-•_....•.-,e,.-. <br /> 7071 <br /> 3 <br /> i <br /> Reviewed Datc Entered Cale: <br /> EHI�inspector: w l3 Initial. <br /> G By Ininal: y <br /> EHD2S-0 I <br /> 0! ;bA8 <br />