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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEI , <br /> 600 East Main Street, Stockton,CA 95202-3 <br /> I/'efephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> kA L Page of I-- <br /> Facility <br /> 'FacWty Address: City: Inspection Date: <br /> LLon� (V� ra-✓I Gl1i S 6 <br /> FA#: /� [ 9 PR#: <br /> O 0� 6 R � �/�Llv s+ Pro'gZnm�3 en�� <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 type. <br /> ❑ Tank(2820) VContainers (2821) #of Containers: / TA#: � ,meg <br /> (>250 gallons) (>55 gallons and<250 gallons) 2 <br /> 1Product Type: &4?;g& <br /> Total Capacity: 2�Q gallons <br /> (pr tank or cumulative for containers by product type) Install Date: <br /> IP/Tank(2820) ❑ Containers (2821) #of Containers: TA#: /25 LlPz J` <br /> (>250 gallo ls) (>55 gallons and<250 gallons) <br /> 2 Product Type: A(,?/,1Q,Qi <br /> Total Capacity: /000�8 gallons Install Date: <br /> (per tank or cumulative for taaoef ,ets by product type) <br /> ❑ Tank(2820) 12"Containers (2821) #of Containers: / TAM �(o <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> LD <br /> 3 Product Type: /?/ �i <br /> Total Capacity: 27 r gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank(2820) containers (2821) ##of Containers: 3 TAM /(0 02 6 <br /> (>250 gallong) (>55 gallons and Q50 gallons) <br /> 4 Product Type:�1XMA LL f/ 21 & <br /> Total Capacity: � .r_gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank(2820) EWontainers (2821) #of Containers TAM j2,-5-7/pa(a <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: AQ/t/rz � <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: 'Z 13 gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> J By Initial: By Initial: <br /> EHD 28-01 <br /> 01/16/08 <br />