BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY --,�ENVIRONMENTAL HEALTH DEPARTMEN's� 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: Page of l_v R !_ G CD �9�O�lR Facility Address: City: Insecho Da PO; C> GkF�O/�f0 FA#. PR N: Program Element: 63 g ® 2 8 31 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. ER'fank(2820) ❑ Containers (2821) #of Containers: TA#: t (>250 gallons) (>55 gallons and<250 gallons) 1 Total Capacity: 1Product Type: �/i9 fT� 0 rs gallons Install Date: (per tank or cumulative for containers byproduct type) 041fank(2820) ❑ Containers (2821) #of Containers: TA#: P6-1 "71c8 / (>250 gallons) (>55 gallons and<250 gallons) 2 Product Type: Iq T Total Capacity: ZS'el gallons Install Date: (per/tank or cumulative for containers by product type) ®'Tank(2820) ❑ Containers (2821) #of Containers: TA#: RI!5 $a (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: 111gE ToQ. /9/ Total Capacity: Z SO gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) Total Capacity this Page: Cie) gallons Total Capacity for Site: 110 gallons Comments: 7 -V; /6ZE L EHD Inspector: Reviewed Date: y Entered Date: By Initial: h.1{-n°' By Initial: EHD 28-01 01/16/08