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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT ' 600 East Main Street, Stockton, CA 95202-302y f Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name f-5- x S's C 91- Page of _� Facility Ad ess: City: Insp n ti Dote: FA#: �� 0 0 PR #: F/7- r6 -,-v g 19,5-T Program Element: 2431 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. Tf Tank (2820) ❑ Containers (2821) #of Containers: TA#: d, 413''1 1 (>250 gallons) (>55 gallons and <250 gallons) Product Type: Gli Total Capacity: / Q Od gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) Containers (2821) #of Containers: TA#: 1951 �Q 2 (>250 gallons) (>55 gallons and <250 gallons) Type: Product T e: ATF Total Capacity: / Zy gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) 19 Containers (2821) #of Containers: y' TA#: 3 (>250 gallons) (>55 gallons and <250 gallons) Product Type: 0/(-- t(--Total TotalCapacity: 7-4.90 d gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) Containers (2821) #of Containers: -S TA#: 4 (>250 gallons) (>55 gallons and <250 gallons) / Product Type: OL L Total Capacity: (0/-) gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) R Containers (2821) #of Containers: TA#: g 5 (>250 gallons) (>55 gallons and <250 gallons) T Product Type: 07/ G - Total Capacity: / 2- O gallons Install Date: (per tank or cumulative for containers by product type) Total Capacity this Page: Z3 `-'V gallons Total Capacity for Site: 2 gallons Comments: EHD Inspector: I Reviewed Date:(l By Initial: U/� -�t 01 Entered Date: By Initial: a�d EHD 28-01 01/16/08