Laserfiche WebLink
4 <br /> � SAN JOAQUIN COUNTY <br /> r ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> x Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: }� <br /> L MC/� Page of <br /> Facility Address: city: Insp,�ictf Dat <br /> FA#: PR#: Program�m t:n <br /> TO <br /> Tank/Container Information <br /> Complete f r all sites with cumulative aboveground storage of petroleum 2-1,320 gallons in tanks*and containers**. <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 1 Total Capacity: 0 gallons Product Type: T <br /> (per tank or cumulative for containers by product type) Install Date: <br /> /Tank (2820) ❑ Containers (2821) #of Containers: STA#: <br /> 2 Total Capacity: p G7 gallons Product Type: _b <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ElTank (2820) F-1Containers (2821) #of Containers: TA#: <br /> 3 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (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 /> ElTank (2820) ElContainers (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: /DOD gallons Total Capacity for Site: f PW gallons <br /> Comments: <br /> Reviewed Date: Entered Date: <br /> EHD Inspector: <br /> By Initial: ` ^,� t{_�,,� 13y Initial: <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 /> 09/12/08 <br />