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MSAN 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 Facility Name: O Dlal/Z,`/ YAlirm3 39-3 _41ageof-� Facility Address: City: Inspection Dt 09 FA#: 11 PR#: Program Element: Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks*and containers**. Complete one box for each tank or each cumulative container product type. ❑ Tank (2820) /containers (2821) #of Containers: 61 TA#: 1 Total Capacity: ?-3 0 gallons Product Type: /41,j (per tank or cumulative for containers by product type) Install Date: feT Tank (2820) El Containers (2821) #of Containers: TA#: 2 Product Type: `- L2., a Total Capacity:/ d PC>>� gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 13 3 Total Capacity: le;, a U gallons Product Type: yam' (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 7� o gallons Total Capacity for Site: 49li o gallons Comments: EHD Inspector: Reviewed Date: Entered Date: L By Initial: �-(� By Initial: *Aboveground storage tank means a tank that 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 AST SURVEY FORM 09/12/08