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SAN JOAQUIN COUNTY <br /> ,"w ENVIRONMENTAL HEALTH DEPARTMENI"f <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 /> Na S+O/) Dv_"� Lp Page -L of � <br /> Facility Address: City: Inspection D to: <br /> 3o � Naves fir. n1 oak -0, � 5 X722 <br /> FA#: PR#: Program Element: <br /> So�2--- 0c-;)2 ­7 gcPco <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks` and containers". <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 1 Total Capacity: a1;J, 000 gallons Product Type: X125 � <br /> (per tank or cumulative for containers byproduct type) Install Date: "w 1 -154-/ <br /> Tank (2820) ❑ Containers (2821) #of Containers: - TAM nl�:5 1 2S 1 <br /> 2 Total Capacity: 1D E is, 000 gallons Product Type: 1�r1 <br /> (per tank or cumulative for containers by product type) Install Date: lel iDq <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: 0 5 1 -7 2t50 <br /> 3Total Capacity: 6"E2, 0 00 gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: 167 '7 <br /> Tank (2820) ❑ Containers (2821) #of Containers: TAnn#: Os) 7 2 53 <br /> 4 Total Capacity: , 302 pOQ/gallons Product Type:��i FAx Q <br /> (per tank or cumulative fw containers by product type) Install Date: 19 Lo <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: D5a20 rf95� <br /> 5 Total Capacity: {7 0.0(� gallons Product Type: LII Q,L t I_00'4-�_ <br /> (per tank or cumulative for con iners by protluct type) Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: 3 Q 1?2 /O CJ gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> By Initial: v 6 , By Initial: � / <br /> 'Abvegf6und storage tank—m-laRrrs a tank that has the capacity to store 51115 gallons or more of petroleum. <br /> "Co finer means a storage device designed to be moved when full. <br /> EHD 28-01 AST SURVEY FORM <br /> 09/12/08 <br />