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SAN JOAQUIN COUNTY ENVAONMENTAL'HEALTH DEPARTMENT 600 l=ast Main Street, Stockton, CA 95202-3029 Telephone:(209)468-3420 Faze;(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND. PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: Page of F ci ity res . �•�- 2 © City: Inspecti0 Date: yr FA#: PR#: g.�2 Program Element: o�2 z Tank/CwWner information Ct mpleto for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks"and containers". Complete one box for each tank or each cumulative container product type. ❑ Tank (2820) containers (282' 1) #of Containers: TA#; 7 L;�> 1 Total Capacity: 76d5V gallants Product Type: 5 oertank orcumulaVvefor ontainers-byprodudtype) Install Date: .❑ Tank (2820) li?Containers (2821) #of Containers: TA#: 2 Total Capacity:. aZ �C) gallons Product Type: ah p 25i'� (per tank or cumulative for containers by product type) Install Date: _ r o C Cu �C aF " L9" Tank (2820) ❑ Containers (2821) #of Containers: TAM _ 3p ' Total Capacity: — r! ' C)�gallons Product Type: -• - -,..— (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) L'Containers (2821) #of Containers: �_ TA#: . �� 4 Total Capacity: 1500 gallons Product Type: (per tank or cumulative for Containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of,Containers: TA#; Total Capacity: Product Type- gailons (per tank or cumulative for containers by product type) Ins#all',Date: Total Capacity this Page: !� - gallons•; Total Capacity for Site: gallons � . Comments: O S 1 -7 31 H f' O(A d S 1'-73 '1 .5 the a AIV- Z22 0 EHD Inspector-,,".... Reviewed Date; Entered Date: 'ay Initial: By Initial: g "Abovegroun ge tank means a at has the capacity to sto a'55 gallons or more f p traleum, oc "`Container ans a storage device designed to be moved when full. EHD 2s-01 48112108 AST SURVEY FORM