Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DBPARTM <br /> 600 East Main Street; Stockton,CA 95202-302 <br /> ` Telephone:(209)468-3420 Fax:•"(209)468-3433 Web..www.sjgov.org/chd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> ( �-5`� G 71 Page of <br /> r <br /> k Facility Address: I City: Insp t' n D te: <br /> ��Da /�0Wj5'GG 40 b0 <br /> FA#: PR#: Pr r t: <br /> j00b $' <br /> Tank/Conta ner Information <br /> Complete for all sites with cumulative aboveground storage of petrolcum L>'1320 gallons in tanks and containers over 55 gallons. <br /> Com Tete one box for each tank or each cumulative container product type. <br /> ❑ Tank (2820) Containers (2821) #of Containers: TA#: <br /> t ( 250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type:. <br /> Total Capacity: gallonsi t <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank 2820 Containers 2821 "' ` <br /> ( ) '�g ( ) #of Containers: TA#: <br /> (>250 gallons) (>55 allons and<250 gallons) 1„ <br /> 2 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for contain by product type) Install Date: <br /> ❑ Tank (2820) '❑ Conta\"rs (2821) #of Containers: TA#: <br /> (>250 gallons) - (>55 gallons ons) <br /> 3 Product Type:Total Capacity: ons `i `? <br /> (per tank or cumulative for containers bye) Install Date: <br /> :W;: <br /> ElTank(2820) ElContainers (282 #of Containers- TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons i,•! .x <br /> 4 Product Type: <br /> Total Capacity: gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank 2820 ❑ Containers 2821 \ <br /> ( ) ( ) #of Containers:" TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 P I�duct Type: <br /> Total Capacity: gallons Instill Dater <br /> (per tank or cumulative for containers by product type) <br /> Total Capacity this Page: gallons Total Capacity for Site: gallons <br /> Comments: <br /> d <br /> I <br /> EHD Inspector: Reviewed E Date: Entered Date <br /> By Initial: wN �,0-Q By In <br /> EHD 2"1 <br /> 01/16/08 <br />