BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

SAN .JOAQUIN COUNTY tNVIRONMENTAL 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 N 13/a%CTpr) l AfiNG%4 Page—,/—of Facility Addre s: City: 2-23 9 S. �� A�� /q Inspection Date: FA #: 3 PR #: 1 06-a 41-3 Progfafn r=lem6nt—: -Z-F2-7 6 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21,320 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 Product Type: Total Capacity: gallons (per tank or cumulative for con ainers By product type) Install Date: PlAlank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ank (2820) ElContainers (2821) #of Containers: TA#: $ ,3$ 3Product Total Capacity: 1)0A' gallons Type: lQ S (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) 2 --Containers (2821) #of Containers: TA#: $ 8 4Product Total Capacity: gallons Type: � � 7 -/)/Z -/al for by (per tank or cumulative c ntainc s product type) Install Date: El Tank(2820) T-16ontainers (2821) #of Containers: TA#: �c�(� j3 a 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 3330 gallons Total Capacity for Site: 3 3 3 gallons Comments: N EHD Inspector:70 Reviewed Date: By Initial: (� ., (�. D°� Entered Date: By Initial: *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. EHD 28-01 AST SURVEY FORM 09/12/08