Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
SAN JOAQUIN COUNTY <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 /> Facility Name: <br /> F <br /> � t 1 <br /> Page of r <br /> Facility Address: city: Inspection Date: <br /> r cls6 <br /> FA Lig (A Yl-7z l6 �I <br /> PR#: Program Element: <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum x1,320 gallons in tanks`and containers`*. <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank (2820) ❑ Containers (2821) "of Containers: TA#: �1{ S�aOI l <br /> 1Product Type: di� <br /> Total Capacity: 'rrL' gallons <br /> (per tank or cumulative for containers by product type) <br /> Install Date: Un,14Awai ] <br /> Tank (2820) ElContainers (2821) #of Containers: TA#: <br /> 2 t Product Type: O' l <br /> Total Capacity: l gallons <br /> (per tank or cumulative for containers by product type) <br /> Install Date: Uti4,:�-xy <br /> [Tank (2820) ❑ Containers (2821) #of Containers: TA#: 16h- D I � <br /> 3 Product Type: <br /> Total Capacity: �rw gallons <br /> (per tank or cumulative for containers by product type) Install Date: LAA'ko rzvva i <br /> ❑ Tank (2820) Containers (2821) #of Containers: 4/ TA#: �h SDI <br /> 4 Total Capacity: 27� Product Type: i <br /> p Y� gallons <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 5 Total Capacity: Product Type: <br /> p y: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: 2 � gallons <br /> Comments: , <br /> EHD Inspector: Reviewed Q Date: Entered Date: <br /> By Initial: 'C (� Z 16 1 �� By Initial: / <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 /> 09/12/08 AST SURVEY FORM <br />