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SAN.JOAQUJN COUNTY ENVIRONMENTAL.HEALTH DEPARTM%..Or' East Main Street,Stockton,CA 95202-3029 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www,sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: "; G 1 �-- W � d � SVCS Page of Facility Address: City: Inspection D It 200 7�G ?�zl aB FA#: PR#: (^ Program lement- a o l Do 3 Tank/Container Inforimation Complete for all sites with cumulative aboveground storage of petroleum z 1320 gallons in tanks and containers over 55'gallons. Comfete one box for each tank or each cumulative container product e. ❑ Tank(2820) Containers (2821) #o€Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons). 1 Product Type: 44 Total Capacity: gallons Install'Date: (per tank or cumulative for conta' ers by product type) ❑ Tank(2820) 1-Containers (2821) #of Containers: f TA#: (>250 gallons) (>55 gallons and X250 gallons) ?y 2 _ Product Type: /1/T/ /#CZ Total Capacity: gallons !:# 4. (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) 9?60ntainers (2821) #of Containers: J TAM (>250 gallons) (>55 gallons and<250 gallons) ► 3 Product Type: Q/ Total Capacity: gallons (per tank or cumulative for containproduct type) Install Date: 1` Tank (2820) -E] Containers (2821) #of Containers.: TA#: (>250 gallons) (>55 gallons and<250 gallons) 4Product Type: bid I r� Total Capacity: Oa gallons t.� (per tank or cumulative for containers by product type) Install Date: _ ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and X250 gallons) 5 Product Type: Total Capacity: gallons (per tank or cumulative for.containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: XXJ gallons Comments: ESD Inspector: _ Reviewed Date: Entered Date: By Initial: -�. y 0 By Initial EHD 2M I 01/16/08