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SAN JOAQUIN COUNTY ENVIRONMENTAL 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 STORAGE PROGRAM SURVEY FORM Facility Name: Aa 1� (/ Page�of Facility Adrgoo ss: City: Inspecti Dat : $y t 60641 ST 5TK �11l vy FA#: D�/ D'Z- 9 3 PR#� � � � ^ Program Element: 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 container product type. ❑ Tank (2820) Containers (2821) #of Containers: TA#:t� (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: p/ L Total Capacity: 7 ? (2 gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank 2820 1? Containers 2821 _ TA#: e951-703S> ( ) ( ) #of Contain (>250 gallons) (>55 gallons and<250 gallons) / ,� / 2 Product Type: 6C)f Y*11 b ir/r O/ G Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) T Containers (282 1) #of Containers: TAM '7 (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: Gt.,-r 7'/w�i.J GC Total Capacity: //0-gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) LB'Containers (2821) #of Containers: z TAM (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: ep, Total Capacity: / ,/ a gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) Containers (2821) #of Containers: TAM (>250 gallons) (>55 gallons and<250 gallons) / _ S C D 5 Product Type: !/!/AS L[�- Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: S gallons Total Capacity for Site: gallons Comments: 3 b EHD Inspector: Reviewed Date: Entered Date: l By Initial: ,1Q By Initial: EHD 28-01 01/16/08