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SAN JOAQUIN COUNTY •, <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility me: <br /> SILL/�� ZZ2LLfI22" 772,2 . <br /> Page of <br /> Facility dress: City: Inspect) n Date: <br /> 0?& D 10 /P�r'. Doe <br /> FA M PR M: Program Element: <br /> -7 -7 2'9-41'r -2 92%,17 <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks'and containers" <br /> Complete one box for each tank or each cumulative container product type. <br /> 'Zf Tank (2820) ❑ Containers (2821) #of Containers: TA#: 0�/-7a <br /> 1 Product Type: /Llyfor o/-/ <br /> Total Capacity: /COU gallons <br /> (per tank or cumulative for containers byproducttype) Install Date: <br /> Tank (2820) ElContair1J r� (2> 21) #of Containers: TA#: <br /> 2 ' <br /> Total Capacity: 0gallons Product Type: G Cw—Oi / <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) J rZonn?iners 2821) #of Containers: J TA#: 0 �/ -7 –7 <br /> 3 Total Capacity: / / O sl allons Product Type: ai oseD� D// <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: CC3/-7 &' <br /> 4 Total Capacity: CJ D O gallons Product Type: Z11.n01<4_1 0// <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> Tank (2820) ❑ Containers (2821) *of Containers: TA#: 045/ 7.3/? I <br /> 5 Total Capacity: 50 C) gallons Product Type: '-'�/Sew 0"/ <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: 19,/ () gallons Totai Capacity for Site: Ali -ell D gallons <br /> Comments: xZ ed7a Do �oo <br /> ¢ ° 7W OeF/ as <br /> r <br /> d �0 aa,07iraAd 710 <br /> 5 577 �O✓�� A�7 P <br /> EHD Insp Reviewed Date: Entered Dale: <br /> �rC By Initial: GA <br /> J It By Initial:J <br /> LJ <br /> *Abo,qAr9plid storage tank means a tank that has the capacity to store 55 gallons or mord of PetroleurA. <br /> "Container means a storage device designed to be moved when full. <br /> EHD 28-07 <br /> 09/12/08 AST SURVEY FORM <br />