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i . •� ,' Al SAN JOAQUIN COUNTYf .x:. ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street,:Stockton, CA 95202-3029 y ' Telephone: (209) 468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEYFORM ' Facility Name t, TPage J of I k Facility Address: city: Inspect' n D e: 2'I o 3 /�' �'/ DI✓ sl h // I� Q FA PR N. Program Element: 3 Tank/Contalher Information Complet for all sites with cumulative aboveground storage of petroleum x9,320 gallons in tanks` and containers**. Complete one box for each tank or each cumulative container product tXee. Tank (2820) ❑ Containers (2821) #of Containers-.",--\ ,TA#: 1 Product Type: Total Capacity: �'O gallons - . (per tank or cumulative for containers by product type) Install Date: ,i ❑ Tank (2820) ElContainers (2821) #of Containers: TA#: I 2 Total Capacity: gallons Product Type: (per tank or cumu#ative for containers by product type) Instal! Date: i� ❑ Tank (2820) ❑ Containers (2821) .#of,Containers: TA#: 3 Product Type: r. Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: El Tank (2820) ❑ Containers (2821) #of'Containers: TA#: 4 Product Type: Total Capacity: gallons i (per tank or cumulative for containers by product type) !'7 Install Date: El Tank (2820) ElContainers (2821) #of Containers:` TA#: 5 Total Capacity: Product Type: . gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 500 gallonsj Total Capacity for Site: gallons Comments: 8' LZ f EHD Inspector: Reviewed Date: Entered Date: By Initial: W`v t k-k%- el By Initial: 11h j *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. "Container means a storage device designed to be moved when full. H EHD 28.01 s I J AST SURVEY FORM 09t12/08 �E _