Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> . ENVIRONMENTAL HEALTH DEPARTME1W <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: Page ` of <br /> ,4 /. ey y <br /> Facility Address: City: Ins�ti%a <br /> � <br /> / .4" /� i o eb rl� <br /> FA#: PR#: Program Element: <br /> 0 0 0 9 R-) 9 ? 1 . <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. <br /> P"1'ank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: w <br /> Total Capacity: /o o /J gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> C�3'Tank(2820) ❑ Containers (2821) #of Containers: TA#: t9,6-1 le 3j9�r <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 / Product Type: <br /> Total Capacity: $e e e gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> CkYTank(2820) ❑ Containers (2821) #of Containers: TA#: "�51 [P(31 C) <br /> (>250 gallons) (>55 gallons and<50 gallons) <br /> 3 Product Type: <br /> Total Capacity: 5-09 gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank(2820) Containers (2821) #of Containers: TA#: B 1'r 3 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: 'at i r <br /> Total Capacity: - gallons T�` <br /> s-� <br /> (per tank or cumulative for containers by product type) Install Date: <br /> 0"'Tank(2820) ❑ Containers (2821) #of Containers: TA#: N e CS 1 a <br /> 5 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> Product Type: <br /> Total Capacity: VO U gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> Total Capacity this Page: ?O �S gallons Total Capacity for Site: 7 Z 7O gallons <br /> Comments: <br /> EHD Inspector: �n Reviewed Date: Entered n Date: <br /> r By Initial: V111' 15.q,,l'e By Initial Jl U <br /> EHD 28-01 <br /> 01/t6/08 <br />