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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,CA 95202-3 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> G J9 7-fS V Page of <br /> Facility Addres City: <br /> Inspec ion at:r , <br /> b2 a RA <br /> FA#: PR#: Prog'rad Element: <br /> aYo13.S�L 1 ao Sze /7/ 2 � <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 /> 1-1 Complete one box for each tank or each cumulative container product type. <br /> ank(2820) ❑ Containers (2821) #of Containers: e TA#: I)29 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: <br /> Total Capacity: /-/D 4& 0 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank(2820) ❑ Containers (2821) #of Containers: TAM 0"'516 T&1 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: RS re� rl/ <br /> Total Capacity: 3 rO gallons <br /> (per tank or cumulative for nZtainers by product type) Install Date- <br /> (per <br /> (2820) ER Containers (2821) #of Containers: TA#: 26—t6-!? d <br /> (>250 gallons) (>55 gallons and<250 gallons) i- <br /> 3 ` Product Type: ,�l��I�' �� .� --7 YIE <br /> Total Capacity: AU gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ank(2820) Containers (2821) #of Containers: ?� TA#,o f 5 1 <br /> 4 <br /> (>250 gallons) (>55 gallons and<250 gallons) Type: <br /> Product T e• <br /> Total Capacity: To e5�7 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) Wontainers (2821) #of Containers: TA#: � I <br /> >250 gallons) ( 55 gallons and<250 gallons) <br /> 5 Product Type: L�(2L3L I� E <br /> Total Capacity: S gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: ral f gallons <br /> Comments: <br /> EHD Inspector: Reviewed ,/ at : Entered Date: <br /> C . By Initial: (, L V� By Initial: <br /> EHD 28-01 <br /> 01/16/08 <br />