Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEIW <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 /> Facility Name:o� J I G ll TO v1Av G Y'nR 121 Page / of / <br /> Facility Address: (� / City: Inspect n at4t. <br /> Z o o J S' NW 5 9 /1? N flrG (/, <br /> FA#: PR#: Program Element: <br /> G603 86 S/ 9 12#AH 2 $ 3 / <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 /> Pj fank(2820) ❑ Containers(2821) #of Containers: TA#: Rl� i; <br /> b <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: �/ `�' <br /> Total Capacity: S��` gallons i <br /> (per tank or cumulative for containers by product type) Install Date: <br /> P I'ank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: l(t( y Q� L/G A (y. <br /> Total Capacity: I'S'O gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> 5 'Tank(2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gailogs and<250 gallons) <br /> 3 ��/� -v Product Type: B <br /> Total Capacity: gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: 4!S j <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 e e Product Type: /a <br /> Total Capacity: 2 e� gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank(2820) ElContainers (2821) #of Containers: TA#: 51 556 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: 17-4x� <br /> Total Capacity: �L o e D gallons Install Date: <br /> (per tank or cumulative for con uettype)\ <br /> Total Capacity this Page: gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHD Inspector: n Reviewed Date: Entered Date: <br /> k/lr/S By Initial: VAJ b,lp,ld By Initial: <br /> EHD 28-01 <br /> 01/16/08 <br />