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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: Stockton East Water District Page 1 of 3 Facility Address: City: Inspection Date: 6767 E. Main Stockton 4/3/2013 FA #: PR #: Program Element: 0004024 1537644 2832 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. X❑ Tank (2820) Containers (2821) #of Containers: TA#: 1 10000 Product Type: dyed diesel Total Capacity: , gallons (per tank or cumulative for containers by product type) Install Date: ❑X Tank (2820) ❑ Containers 2821 ( ) #of Containers: TA . 2 2,000 Product Type: diesel Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: #of Containers: TA#: X❑ Tank (2820) ❑ Containers (2821) 3 Product Type: 87 octane gasoline Total Capacity: 5,000 gallons (per tank or cumulative for containers by product type) Install Date: X❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: �So�ftS�,h 4 100 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ) ❑X Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5100 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ) Total Capacity this Page: 17,200 gallons FTotal Capacity for Site: 18,910 gallons Comments: EHD Inspecto . Reviewed Date: By Initial: \ Entered D By Initial: ) — *Abo egr d bragthat has the capacity to store 55 gallons or more of petroleum. —Container means a storage device designed to be moved when full. EHD 28-01 REV 04/19/12 AST SURVEY FORM