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SAN JOAQUIN COUNTY -. <br /> ENVIRONMENTAL HEALTH DEPARTMEP Xs, <br /> 600 East Main Street,Stockton,CA 95202-302Y <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> VEGROUND PETROLEUM TORAGE PROGRAM SURVEY FOkM <br /> Facility Name <br /> — Page of 71 <br /> Facility Address: City: Inspec ion ate: <br /> -! 0-2, o S - T r✓` LV � 6� <br /> FA#: G �� PR 5 #: Program Element: <br /> 5 / S V Fr.3_, <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21320 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#: (96)/o Dalp <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: Ate <br /> Total Capacity: Z2b i d 0 r2 gallons <br /> (per tank or cumulative for ontainers by product type) Install Date: pi i 5 <br /> Tank(2820) ❑ Containers(2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: <br /> Total Capacity: / ° 0 ° gallons <br /> (per tank or cumulative for containers by product type) Install Date: LDa{.pf : (O� <br /> ,Tank(2820) ❑ Containers (2821) #of Containers: TA#: aD';R� <br /> (>250 gallons) (>55 gallons and<250 gallons) ,r <br /> 3 Product Type: LS Bj <br /> Total Capacity: XENM allons "'"� � (_�I /�r,^ //�� <br /> (per tank or cumulative for in by product type) Install Date: �b(�I�eA 14-bo R- kt&Q[ o;( �1/l I NKt% <br /> 7 Tank(2820) ❑ Containers (2821) #of Containers: TA#: e6-,21-9 Q 5 R 3 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: <br /> Total Capacity: gallons &- UW ail ,�� <br /> (per Tank or cumulative for con ers by product type) Install Date: �Ira}ed,—lam� <br /> Tank(2820) ❑ Containers(2821) #of Containers: TA#: fj5�p 5-S <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: 1'lAI)hr( <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: /4-j-(,{-p d '- tA" k L� Olt _Cjhn i1D <br /> Total Capacity this Page: gallons Total Capacity for Site: - gallons <br /> Ceme,IU5 E A" LA <br /> rtt <br /> EHD Inspector: Reviewed te: (J Entered Date: <br /> By Initial: <br /> ( q /VIrJ/C By Initial: ij <br /> EHD 28-01 <br /> 01/16/08 CJ <br />