Laserfiche WebLink
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.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> RT v Lr k Page of <br /> Facility Address: City: Inspection D <br /> �3 5 i�• �Gv Z� :d <br /> FA#: PR#: Prog raeh F,em qnt <br /> I .7 3 C� <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks'and containers"*. <br /> Com fete one box for each tank or each cumulative container product type. <br /> Tank (2820) ElContainers (2821) #ofi Containers: TA#: <br /> 1 Total Capacity: 3 S-0 gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Vr/Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 2 Total Capacity: 3 gallons Product Type: <br /> (per tank or cumulative for contain rs by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 3 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ElTank (2820) ElContainers (2821) #of Containers: TA#: <br /> 4 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 5 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> By Initial LJ1`{� By Initial; C <br /> *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 moved when full. <br /> EHD 28-01 AST SURVEY FORM <br /> 09112/08 <br />