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SAN JOAQUIN COUNTY D ENVIRONMENTAL HEALTH DEPARTMEN 600 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: (5 ��-DL K-� M V Page AL of Facility Address. City: Inspec ion Date Soc �l--J Ll z c 7 61 FA#: PR#: Program Element: � vv0 83 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum �-1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type, (>2Tank (2820) ElContainers (2821) #of Containers: TA#: 4S6-1106!y 50 gallons) (>55 gallons and<250 gallons) 1 Product Type: 2e�, Total Capacity: Z E OlS U gallons Install Date: (per tank or cumulative for containers by product type) Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 2 Product Type: Total Capacity: 2 10(S V gallons (per tank or cumulative for containers by product type) Install Date: Y 14j Tank(2820) ❑ Containers (2821) #of Containers: TA#: 4� 49P'1 I (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: Total Capacity: V U 1) gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: d 4 O (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: vjp4A-- Luk �Z Total Capacity: SIS J 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 Total Capacity for Site: yo Z) gallons Comments: EHD ector: Reviewed Dale: Entered Date: U' By Initial: \J JZ� By Initial: EHD 28-01 01/16/08