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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> East Main Street, Stockton,CA 95202-30APW <br /> Telephone.(209)468-3420 Fax.(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: p <br /> /� R1vS p -r Page of <br /> Facility Address: rcity. Inspect <br /> i D lei <br /> 2 S A)A /e/ 0S A /�_I _`��"' ST-/G G <br /> FA#: PR#: Program Element: <br /> 0 2-/ 1 65 z 8 <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 <br /> I�IrTank(2820) ❑ Containers (2821) #of Containers: TAM Zj�� <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> I Product Type: /Zj O 7792 O <br /> Total Capacity: � gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> link(2820) ❑ Containers(2821) #of Containers: TA#:_ 1517'��53 <br /> 2 <br /> (>250 gallons) (>55 gallons and X250 gallons) / <br /> Product Type: (ilk.R S j <br /> Total Capacity: ? 00 gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> Tank(2820) Cl Containers(2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: � <br /> Total Capacity: ' 117 n O gallons Install Date: <br /> (per tank or emulative for containers by product type) . y� <br /> ❑ Tank (2820) Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: <br /> Total Capacity: gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank(2820) ❑ Containers (282 1) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> Product Type: <br /> Total Capacity: gallons Install Date: <br /> (per tank or emulative for containers by product type) - <br /> Total Capacity this Page:2 ZS d gallons Total Capacity for Site: -z— Z-5-6 {gallons <br /> Comments: <br /> EnD Inspector. Reviewed Date: Entered Date: <br /> / By Initial: Wo ,(� By Initial: <br /> EHD 28-01 <br /> 01/16/08 <br />