BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMEN- ,JO East Main Street,Stockton,CA 95202-302- Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Na "� L-IZ 1�+ G V G N Page of Facility Address: ICity: Inspection Date: / LO c v 1 A V r , of� s z I IVY 3/Z Z FA#: PR#: Progr m Elemen 000 102# 9 1 5' S' X66 1 Z$ 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 (282 1) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 1 23 p Product Type: �lk-4 j RF (2, Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) Containers (282 1) #of Containers: TAM &S-Z (P D (>250 gallons) (>55 gallons and<250 gallons) 2 (-t`3-o) Product Type: Total Capacity: S Sx L} gallons (per tank or cumulative for containers by product type) Install Date: Tank(2820) ❑ Containers (2821) #of Containers: / TAM ��! /P (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: Total Capacity: //0/0 o d 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) 4 Product Type: Total Capacity: 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) $ Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: % 5 gallons Total Capacity for Site: ,�®� s /L/ gallons Comments: c o .,�•�-c rS G07 lLi n� EHD Inspector: Reviewed Date: Entered D e: C�- ! By Initial: V,IJ S (1•p� By Initial: EHD 28-01 01/16/08