BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY NVIRONMENTALHEALTH DEPARTMEN' East Main Street,Stockton,CA 95202-302V"O' Telephone.(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: / Page of Ci r x of Loo �&(I # zl Facility Address: City Inspection Dat Z 190 pl, (eD 'N CS L d FA#: PR#: Program Element: /20 12 17 2 1O oZ$lF 2 '$q0 Tank/Container Information Complete for all sit 'th cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. Co Tete one box for-each tank or each cumulative container product ❑ Tank(2 20) Containers (282 1) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) D 1 Product Type: Total Capacity: �f d� gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (282 1) #of Containers: TAM (>250 gallons) (>55 gallons and<250 gallons) 2 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) 3 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) 4 Product Type: Total Capacity: gallons Mall Date: (per tank or cumulative for containers by product type) ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAN: (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: gallons Comments: / Ya EHD Inspector: Reviewed Date: Entered Date: By initial: .k-W By Initial: EHD 28-01 01/16/08