Laserfiche WebLink
SAN JOAQUIN COUNTY 0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax.(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facilit=y Name: <br /> / <br /> Page of Avoct <br /> Facility Address: City: Inspection 1 Date: I <br /> �0 N1Uw (n kw I�-b„Wi Vp.L o IL 4 . <br /> FA M //ll PR M Program Element: <br /> 0V <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks' and containers". <br /> Complete one box for each tank or each cumulative container product type. <br /> ElTank (2820) ZlContainers (2821) #of Containers: TAM <br /> 1 0-5DProduct Type: C� �. t <br /> Total Capacity: � gallons <br /> (pertank or cumulative for containers byproducttype) 6(w{6n 375T70—Install Date: <br /> ❑ Tank (2820) 0Containers (2821) #of Containers: ( TA#: �5 <br /> 2 Total Capacity: �gallons Product Type: i f L <br /> (per tank or cumulative for coma ners by product type) Install Date: 10160W:Wa <br /> ❑ Tank (2820) ZContainers (2821) #of Containers: TA#: A2'TjDf>/v� <br /> 3 <br /> � j (tr�o+�.�Uce oilTeed <br /> Product Type: <br /> 0 <br /> Total Capacity: �,� gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> 0-Tank (2820) E) Containers (2821) #of Containers: TA#: 6f5aO,�4- <br /> 4Product Type: t�P ,L <br /> Total Capacity: 218Z gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ,Tank (2820) ❑ Containers (2821) #of Containers: TA#: if ri'aOD <br /> 5 Total Capacity: gallons Product Type: "td rad I,(>_ q <br /> (per tank or cumulative for containers by product type) b�h U A:5 Ylvl fkj <br /> Install Date: <br /> Total Capacity this Page: b gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> a(.D -kl Bylnitial: A ' CL 'i By Initial: �2c al (( <br /> 'Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. <br /> "Container means a storage device designed to be moved when full. <br /> EHD 28-01 <br /> 09/12/O8 AST SURVEY FORM <br />