Laserfiche WebLink
SAN JOAQUIN COUNTY <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 />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 28-01 <br />09/12/08 AST SURVEY FORM <br />Page of Z <br />Facility Address: <br />City: <br />Inspection D te: <br />I -,-1 I (, 1� "-� %<<ti J? <br />'/k <br />�, <br />FA #: PR #: <br />Program ement: <br />223 <br />Tank/Container Information <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) 0 Containers (2821) <br />#of Containers: -- TA#: <br />1 <br />Total Capacity: 2 X gallons <br />p Y� � �� <br />Product Type: o i S -a ( vc�- CPa�/}-c W <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />❑ Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: <br />2 <br />Total Capacity: gallons <br />Product Type: <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />❑ Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: <br />3 <br />Total Capacity: gallons <br />Product Type: <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />❑ Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: <br />4 <br />Total Capacity: gallons <br />Product Type: <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />❑ Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: <br />5 <br />Total y: gallons Capacity: <br />p <br />Product Type: <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />Total Capacity this Page: S- gallons ITotal <br />Capacity for Site: Z3� gallons <br />Comments: <br />EHD Inspector: / <br />0 L, <br />Reviewed Date: (� <br />By Initial: <br />Entered Date: I <br />By Initial: <br />3-1) q <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 28-01 <br />09/12/08 AST SURVEY FORM <br />