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. - - SAN JOAQUIN COUNTY i 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: AA �ACb TranSto ?5f o Page of Facility Address: city: Inspe tion D te: 2 5 c o M � I 'Ab� -S7'-v6Z�-►J L/ 22 0 4 FA M. PRM Pro ram Element: D 05 2 C-(n 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. Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1Product Type: . Total Capacity: Sop gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) ElContainers (2821) #of.Containers: TA#: 2 p Z� S' Product Type: Total Capacity. gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 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: Product Type: gallons (per tank or cumulative for containers by product type) Install Date: ElTank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: gallons Comments: EMD inspector: Reviewed Date: Entered Date: p By Initial: y�a` 1 By Initial: ko 'q D "Aboveground stor ge tank means a tank that has the capacity to store 55 gallons or more of petroleum. **Container means a storage device designed to be moVeddwhen full. EHD 28-01 ASTSURVEY FORM o9r i erne