Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> .NVIRONMENTAL HEALTH DEPARTMENT <br /> b0 East Main Street,Stockton,CA 95202-302�"r <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.orglehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name✓�� Page of <br /> Facility Address: W p� City: <br /> 0,41- 3 I , ��� a <br /> FA#: PR#: Program Element: <br /> ig <br /> 3541 jo $ - 2 $ 3/ <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 /> Com tete one box for each tank or each cumulative container product <br /> ank(2820) Containers (2821) #of Containers: �_ TAMa <br /> (>250 gallons) (>55 gallons and<50 gallons) 0� <br /> 142V Product Type: i� -L�C�N-Ccj <br /> Total Capacity: f12 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> L'4/Tank(2820) S Containers(2821) #of Containers: TAM /9,S/7 <br /> (>250 gallons) 1� ,(�55 gallons and<250 gallons) ' <br /> 2 FSZsv Product Type: /Vl eToer� <br /> Total Capacity:�gallons Install Date: <br /> (pa tank or cumulative for containers by product type) <br /> ank(2820 Containers (2821) #of Containers: TA#: 12517 7 <br /> (>250 gallons) J t-/(S55.gallons and<250 gallons) ^ 7— <br /> 3 C ) Product Type: Al e/0fL O! L <br /> Total Capacity: g ons Install Date: <br /> (pa tank or cumulative for containers by product type) <br /> (2820) Containers (2821) #of Containers: TA#: 19,5/7c_75h� <br /> (>250 gallons) (>55 gallons d 1250 gallons) <br /> 4 � Product Type: /'L/BT/1I>✓ � r t/ <br /> Total Capacity: Ogallons Mall Date: <br /> (per tank m cumulative for cotainers byInduct type) <br /> C1 Tank(2820) MnContainers(2821) #O f C ; 0 <br /> (>250 gallons) (>55 gallons and<250 gallons <br /> 5 Product Type: �1y02IaC,l Q! J <br /> Total Capaci a gallons Install Date: <br /> m cumulative for containers by product type) <br /> Total Capacity this Pag 115&O _ gallons I Total Capacity for Rite: _cellons <br /> Comments: � 1/C� � <br /> 7 C <br /> is .P-O dff 10 ZJ2 49=L6 <br /> -` Z/ IS <br /> th <br /> u Il <br /> EHD Inspector: I Reviewed Date: Entd Date: <br /> By Initial: Y)),O ere <br /> By Initial: Il <br /> EHD 28-01 /C <br /> 01/16/08 7 <br />