Laserfiche WebLink
a, <br /> SAN JoAQUIN COUNTY ~� ,......}.�--. <br /> ENVIRONMENTAL-'HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton-, CA 95202-3029 <br /> Telephone:.(209)468-3420 Fax: (209)'468.3433 Web:www.sjgov.orglehd <br /> ABOVEGROUND PETROLEUM STORAGE' PROGRAM SURVEY.FORM. <br /> Facility Name: <br /> G <br /> Page of . <br /> Facility Address: �, City: r Inspection ate: 0 <br /> FA#: R#: Progr m lem <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum al,320 gallons in tanks`and containers**. <br /> Complete one box for each tank preach cumulative.container product type. <br /> iTank (2820). ❑ Containers (2821) #of Containers:--, TA#: <br /> 1 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for cohlainers by product type) <br /> Install Date: <br /> Tank (2820) ❑ Containers (2821) #of Containers. TA#: <br /> 2 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative-f stainers by product type) Install Data: <br /> I <br /> #ofi Containers: TA#: <br /> ❑ Tank (2820) Containers (2821) ,, 1 <br /> 3 [ Product Type: JAI fi %TF, d l V <br /> Total Capacity: J gallons <br /> (per tank or cumulative for containers by product type) Install Date: ' <br /> i <br /> EJ Tank (2820) L-1-Containers (2821) <br /> #of Containers: TA#: <br /> `i <br /> 4 Product Type: <br /> Total Capacity: �I 000 _gallons <br /> (per tank or cumulative for conuanaers oy product type) Install Date: <br /> ElTank (2820) EJContainers (2821) #of Containers: TA#: <br /> t 5 Product Type: <br /> Total Capacity: gallons <br /> 1 (per tank or cumulative for containers by product type) Install Date: x <br /> Total Capacity this Page: f.0 <br /> T gallon;s Total Capacity for Site: gallons <br /> i Comments: <br /> DDS aiqdtil - �p S 77 a, <br /> ry 3� 10 <br />( <br /> 1 <br /> EHD Inspector: -Reviewed Date: Entered Date: <br /> By Initial: By Initial: ke <br /> a` <br /> t *Aboveground storage tank means a tank that has the'capacity to store 55 gallons or more of petroleum. <br /> *Container means a storage device designed to be riioved when full. <br /> EHD 28-01 AST SURVEY FORM <br /> 09/12/08 <br />