BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMEN' 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: S'n1'_-1'1'Aly ul—L6A& Page of Facility Address: City: P s P F�� flvr Dat Ins77-L-7og FA #: oao 2836 PR #: S/ tl 9 Program Element: 1 28 1 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum >_ 1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. la,1ank (2820) ❑ Containers (2821) #of Containers: TA#: � 1 (>250 gallons) (>55 gallons and <250 gallons) 1 Product Type: �D."(� Total Capacity: 10,061 gallons ate:"(per tank or cumulative for containers by product type) Install Date- "a a (2820) ❑ Containers (2821) #of Containers: TAh: � 3 (>250 gallons) (>55 gallons and <250 gallons) 2 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM (>250 gallons) (>55 gallons and <250 gallons) 3 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM (>250 gallons) (>55 gallons and <250 gallons) 4 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 (>250 gallons) (>55 gallons and <250 gallons) Product Type: Total Capacity: gallons Install Date: ta (per Link or cumulative for containers by product type) Total Capacity this Page: gallons Total Capacity for Site: ZG gallons Comments: IEHD Inspector: �) —4 Reviewed Date By Initial: Entered Date: By Initial � # EHD 28-01 01/16/08