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SAN JOAQUIN COUNTY *W.0e ENVIRONMENTAL HEALTH DEPARTMENT 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: IAI r- L D 0 I G G 2 Page __L of Facile Addre "' City: Inspecti n Date: x-375 : W 2 SAG Aot7, FA C PR N: Program Element: i 8 e o ZS B Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum ?1,320 gallons in tanks'and containers". / Complete one box for each tank or each cumulative container product type. H Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Total Capacity: gallons Product Type: 0,A, (per tank or cumulative fortainers by product type) Install Date: IWTank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Product Type: (YID Total Capacity: � o Z�gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: / gallons Total Capacity for Site: /&-av gallons Comments: FEHD Inspector: Reviewed Date: Entered By Initial: vl_I V •'�(•0 By Indial: "Aboveground storage tank means a tank that has the capacity to store 55 gallons or more cl petroleum. "Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08