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SAN JOAQUIN COUNTY � / <br /> ENVIRONMENTAL HEALTH DEPAR'ffylEN <br /> '*-600 East Main Street, Stockton,CA 2-30291M <br /> Telephone:(209)468-3420 Far:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FO <br /> Facility Name: <br /> C q Z_ d N� Page of_L_ <br /> Facility Address: MInsp ion <br /> 5rq 0'7 <br /> FA#: #: Program Element: <br /> oo0s-S �co SZzI $ v 2g'�v <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallo s. <br /> Complete one box for each tank or each cumulative container product IP"' <br /> ank (2820) ❑ Containers (2821) #of Containers: /TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: <br /> Total Capacity:l0 1 D a gallons <br /> (per tank or cumulative for containers by product type) Install Date: Ac ^yg—r , <br /> Tank(2820) ❑ Containers (2821) #of Containers: A#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 2- S d U Product Type: <br /> Total Capacity: �_dgallons Install Date: APR T1 G <br /> (per tank or cumulative for con ers by product type) <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM T S <br /> (>250 gallons) (>55 gallons and<250 gallons) a.� eyl <br /> 3 Product Type: <br /> Total Capacity: gallons A+t <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: gallons <br /> Comments: <br /> IiC/ a.3 o- e <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> By Initial: W� 5-Lo- k By initial: �'(,(/ !1 <br /> EHD 28-01 <br /> 01/16/08 t <br />