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<r `� SAN JOAQUIN COUNTY �r 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: ELC LO FAtm4.3 Page —,/ of Facility A dress: City: Inspectio Date: 0 FG u c lD� Z 41 FA s: PR#: Program Elent n _ Seq 42 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum ;0,320 gallons in tanks'and containers". Complete one box for each tank or each cumulative container product type. ank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Total Capacity: 0 O gallons Product Type: r"—4 if (per tank or cumulative for containers by product type) Install Date: �nk (2820) El Containers (2821) #of Containers: /� TA#: 2Product Type: Total Capacity: � rrt7 gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM 3 Total Capacity: gallons Product Type: (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: d gallons Total Capacity for Site: /-00-0 gallons Comments: :Ya ZDIV-4r:7 44244-7 /=' EHD Inspector: Reviewed Date: Entered Date: f By Initial: ( ' A- By Initial: ef a 9° '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. END 28-01 AST SURVEY FORM 09/12/08