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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> A0 East Main Street, Stockton,CA 95202-302: <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: a <br /> r I Page of <br /> �1 Alj G i� s. �'li ?�� o r✓ <br /> Facility, r City. Inspecjjion ate: <br /> � 3 fly CST 1F,520 l s T/ 7p8/ds <br /> FA#: PR#: Program Element: <br /> c o o a a8��9' 2$3 Z_ <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 /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) �— <br /> 1 Product Type: :y,:;= 7- <br /> Total <br /> Total Capacity: Z. O C,G a gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: L4 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: /.I Y* jtgs <br /> Total Capacity: / 2v o d gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: B (ZP l lO� <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: 0-0-A S - /e>O <br /> Total Capacity: l Z 0'0 0 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: eS,5-1 Z2?749 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: A 45�p S <br /> Total Capacity: 2-0-000 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <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: 4/ d gallons Total Capacity for Site: p gallons <br /> Commen JOg !��(yliGA/1. •MA(,50�fVC <br /> Y Z 4iq 41 <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> By Initial: ` ,,� -��V-0/ By Initial: $' I[Lb!d <br /> EHD 28-01 v� <br /> 01/16/08 <br />