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SAN JOAQUIN COUNTY <br /> NVIRONMENTAL HEALTH DEPARTMENT <br /> uu0 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: Page '� �of <br /> SAL) TATS T V�- SE a ✓l('0 <br /> Facility Address: City: Inspection Da <br /> FA#: PR#: Prog m E ement: <br /> 1 22 9-3 <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 Nox4 each tank or each cumulative c ntainer product type. <br /> ❑ Tank (2820) �('5 <br /> Containers (2821 #of Containers: TA#: <br /> (>250 gallons) gallons and<250 gall <br /> 1 Product Type: <br /> Total Capaci • ons <br /> (per ulative for containers by product type) Install Date: <br /> ❑ Tank (2820) �(>5 <br /> Containers (2821) #of Containers: TA#: <br /> (>250 gallons) gallons and<250 gallons <br /> 2 Product Type: � 6>o/Z <br /> Total Capacit : - allons <br /> (per urnulative for containers by product e�\\ Install Date: <br /> Tank(2820) ❑ Containers (282 1) #of Containers: TA#: 05/7A <br /> >250 gallons) (>55 gallons and<25 <br /> 3 Product Type: O J d 62 i U <br /> Total Capacity: D gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: ja(^Jv gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> By Initial: By Initial: <br /> EHD 28-01 <br /> 01/16/08 <br />