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SAN JOAQUIN COUNTY <br />'ENVIRONMENTAL HEALTH DEPARTMEN" <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br />ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br />Facility Name: <br />ISL U !L <br />P41 <br />Page 7 of <br />Facility Address: rCity: <br />C4 <br />S L <br />Inspecti Date: <br />CF/0 <br />FA #: <br />�!� <br />PR #: <br />PrograElement: <br />m 2 <br />Tank/Container Information <br />Complete for all sites with cumulative aboveground storage of petroleum >_ 1320 gallons in tanks and containers over 55 gallons. <br />Complete one box for each tank or each cumulative container product type. <br />Ta(2820) El Containers (2821) <br />#of Containers: TA#: <br />1 <br />(k50 gallons) (>55 gallons and <250 gallons) <br />Product Type: y�l _�-/ ��� 4>--4-r <br />Total Capacity: 2 "A gallons <br />, <br />` <br />Install Date: <br />(per tank or cumulative for containers by product type) <br />kr Tank (2820) ❑ Containers (2821) <br />#of Containers: TAM _ 9 <br />2 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Product Type: (Z,e..-, Irl e -w <br />Total Capacity: 031-11 gallons <br />, <br />(per tank or cumulative fo containers by product type) <br />Install Date: <br />X Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: D515 ' '`�07 <br />3 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Total Capacity: 3 <br />Product Type: p r L rCl L+\, �) JE) , <br />gallons <br />(per tank or cumulative f r containers by pr duct type) <br />Install Date: <br />Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: <br />4 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Product Type: pr, 2 M „ (Q,ql t4 6P T1 <br />Total Capacity: 26 1 13 3 gallons <br />(per tank or cumulative For containers by product type) <br />Install Date: <br />tg Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: <br />5 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Product Type: <br />Total Capacity: 3 .� gallons <br />Install Date: <br />(per tank or cumulativ f rntainers product type) <br />Total Capacity this Page: 2 gallons <br />Total Capacity for Site: b 7 2 3 / 2 gallons <br />Comments: <br />EHD Ins tor: <br />t^ � <br />Reviewed <br />By Initial: <br />Date: <br />Entered Date: <br />By Initial 6 <br />EHD 28-01 <br />01/16/08 <br />