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SAN JOAQUIN COUNTY `oo <br /> �.. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax: (209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name:IAN l /oTFS/s k, Page / Of <br /> Facility Address: clInspect) n D : <br /> I S • MA NTG CF{ 9 /7 0 <br /> FA M: PR C Program Ele n : <br /> 6 - o -z 8 70 <br /> Tank/Container Iriforniation <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks'and containers". <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank (2820) 1:1Containers (2821) #of Containers: 'fA#: <br /> 1 Total Capacity: 3_�gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity: <br /> 05 Tank (2820) El Containers (2821) #of Containers: // TA#: <br /> 2 2 rgallons Product Type: IrN S 12 <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) El Containers (2821) #of Containers: TA#: <br /> 3 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 4 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 5 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> Total Capacity this Page: V 0 gallons Total Capacity for Site: 37? gallons <br /> Comments: /V G` <br /> J <br /> .<1/AVJ f 7- Ol <br /> EHD Inspector: Reviewed , ,I Date Entered Entered Date <br /> By Initial: Wv "1-Ib, By Initial: <br /> 'Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. <br /> "Container means a storage device designed to be moved when full. <br /> EHD 26-01 <br /> 09/12/08 AST SURVEY FORM <br />