Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> fENVIRONMENTAL;HEALTH DEPARTMEN <br /> 600 East Main Street,'Stockton,CA 95202-302 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Weh:'WWW.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> Page' of <br /> Facility Address: ` City: Inspecti n D te: <br /> -3o33 Nom` �yg S.T� rte! q1 0 <br /> FA#: PR#: Program Element: <br /> Tank/Cointainer Information <br /> Complete for all sites with.cumulative aboveground storage of petroleum 2t1!320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or.each cumulative container product type. <br /> Tank(2820) ❑ Containers (2821) #dContainers:- TA#: <br /> (>250 gallons) (>55 gallons and 450 gallons) . <br /> 1 Product Type: D W_� <br /> Total Capacity: 6 fl gallons <br /> (per tank or cumulative for containers by product type) Install Date. <br /> @'Tank (2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and 450 gallons) I` <br /> 2 Product Type: <br /> Total Capacity: . SOP gallons <br /> (per tank or cumulative for containers by product type) Install Date: T JO Lj-f- 'rjQ lG <br /> ❑ Tank (2820) ❑ Containers(2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and 450 gallons) <br /> 3 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (2821) #oMontainers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type:' <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Eir <br /> ❑ Tank(2820) Containers (2821) #of.Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type:' . - <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: lO eo gallon`s Total Capacity for Site: /D 0 gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: Entered Date- <br /> By Initial: ry.A By Initial: P <br /> EHD 28-01 <br /> 01/16/08 <br />