BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 00 East Main Street,Stockton,CA 95202-30 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: S Page of Facility Address: City: Inspection D e: LC FA#: / PR#: Program Element: Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 2�t 1320 gallons in tanks and containers over 55 gallons. Com ete one box for each tank or each cumulative container product type. ❑ Tank(2820) Containers (2821) #of Containers: TA#: A2 (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: (2820) El-Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 2 Product Type: �^ D 6 �/ Total Capacity: SOB gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons I Total Capacity for Site: j gallons Comments: EHD Inspector: ' reviewed Date: ^ t Entered D e: By Initial: (r�� `� ��\ By Initial: 4 EHD 28-01 J 01/16/08 /y