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SAN JOAQUIN COUNTY <br /> `ENVIRONMENTAL HEALTH DEPARTMEN <br /> 600 East Main Street,Stockton,CA 95202-30)VO <br /> Telephone:(209)468-3420 Far(209)468-3433 Web.www-sjgov.org/chd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> TI✓GA 4 Ll Tq 1,AZ A d3wc1<. or i/ M G Page of / <br /> Facility Address: City: Inspection Date: <br /> // 90 s • ANT/eCA <br /> FA#: 9/ PR#: lemevt: Z <br /> 0 00 3 5 19<3 1Z <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 <br /> Tank(2820) ❑ Containers (2821) #of Containers: TAM t <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: n i r✓ <br /> Total Capacity: 300 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) Containers (2821) #of Containers: _L TAM _ <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: 0/ /, <br /> _ <br /> Total Capacity: Z Z 0 gallons <br /> (per tank or cumulative for containers by product type) Install Date: _ <br /> ❑ Tank(2820) aKontainers (282 1) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: —A%`.F <br /> Total Capacity: //0 gallons Mall Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank(2820) Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) / <br /> 4 Product Type: �} �'RO,S���✓6 __ _ __ _ <br /> Total Capacity: SS gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> Tank(2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: �/G <br /> Total Capacity: Ll 3 b gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> Total Capacity this Page: / gallons Total Capacity for Site: �/ �f gallons <br /> Comments: <br /> EHD inspector: Reviewed Date. Entered Dat <br /> By Initial: By Initial: I(E O <br /> EHD 28-01 <br /> 01/16/08 <br />