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SAN JOAQUIN COUNTY 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 oveground storage tank means a tank that has the capacity to store 55 gallons or more df petroleum. "Container means a storage device designed to be moved when full. EHD 28-01 09/12/08 AST SURVEY FORM Page of . Facility Address: City: Inspection Date: FA #: PR #: Program Element: ° 3� Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 2,1,320 gallons in tanks` and containers". Complete one box for each tank or each cumulative container product type. Tank (2820) ❑ Containers (2821) #of Containers: TA#: /9,5,Qo aq'3 1e: Total Capacity: 100-0 Product Type: yp g a (per tank or cumulative for containers by product type) Install Date: f 12 Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2Product Total Capacity: i gallons Type: �„� (per tank or cumulative for containers by product type) Install Date: 13 Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Total Capacity: � Product Type: .P,rnn 1 4-117,570gallons (per tank or cumulative for containers by product type) Install Date: Ln'n4vt ..� f Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4Product Total Capacity: 2Sy gallons Type: (per tank or cumulative for containers by product type) Install Date: 0 Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: 'j,""1.)gallons Product Type: i66n42L , (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: -L gallons Comments: EHD Inspector:Reviewed /� /�✓�'l. 12N` "Ab By Initial:) Date: Entered Date: By Initial l oveground storage tank means a tank that has the capacity to store 55 gallons or more df petroleum. "Container means a storage device designed to be moved when full. EHD 28-01 09/12/08 AST SURVEY FORM