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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTME <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 Name: Page of / <br /> � OVO tAc, T <br /> Facility Address: City: Inspect'r)n�Djaa e/® (J <br /> 232 Loi/"rL �- S 1l o <br /> FA#: PR#: Program Element: <br /> Deo <br /> Tank/Container Information <br /> Complete f all sites with cumulative aboveground storage of petroleum >1320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank(2820) ❑ Containers (2821) #of Containers: ,TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) z <br /> 1 Product Type: <br /> Total Capacity: / 0 000 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) elcontainers (2821) #of Containers: �'f T <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: <br /> Total Capacity: � gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> 1 <br /> ank(2820) ❑ Containers (2821) #of Containers: TA#: 19,z5-f6 qf2 <br /> (>250 gallons) (>55 gallons an 50 gallons) <br /> 3 � Product Type: /A� /�S�� <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: ��/le Y <br /> (>250 gallons) (>55 gallons and<250 gallons) ' <br /> 4 �� � Product Type: / �1 [i D�` <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank(2820) Containers (2821) #of Containers: TA#: &5-1(Q �'D& <br /> (>250 gallons) (>55 gallons and<250 gallons) T <br /> 5 1-1 Product Type: 4101'00q, OCA <br /> Total Capacity: 2 gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> Total Capacity this Page: 0 gallons FTotal Capacity for Site: 0 3 gallons <br /> Comments: <br /> N Ln rR 6 <br /> EHD Inspector: Reviewed Date: ,/ Entered Date; <br /> By Initial: IJ�T 5.21-0 b By Initial: l/fin <br /> EHD 28-01 <br /> 01/16/08 <br />