BILLING - Laserfiche WebLink

Home Browse Search

E SAN JOAQUIN COUNTY . ENV IRONMENTAU HEALTH DEPARTMENT �. 600 East Main Street,Stockton,CA 95202-302 Telephone:(209)468-3420 Fax:(209)468-3433 Web.www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility NrA'*, I 14z?Q C I J y D'r (/t/ �/ Page of Facility Address: City:; InspeElement- FA Date:' Zool . T _T#: PR DO alb 95aT6 43'. � TanklContainer:Jnforn iation Complete for all sites with cumulative aboveground storage of petroleum �t:1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each}cumulative container 2roduct e. Tank(2820) ❑ Containers (2821) #df Containers: T #:. (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: Total Capacity: 'Z,5'b gallons (per tank or cumulative for containers by product type) Install Date: 0 Tank (2820) ` ❑ Containers (2821) #of Containers: TA#: (>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: TA#: (>250 gallons) (>55 gallons and<250 gallons) 3 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) 4 Product Type: Total Capacity: gallons. I (per tank or cumulative for containers byproduct type) Install Date' ❑ Tank(2820) . ❑ Containers (2821) #o f Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: Total Capacity: gallons }. . `:., (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: s p gallons r —. Total Capacity for Site: ZSD gallons Comments: J !� S EHD Inspector: ReviewedDate: Entered D kL By Initial: Lt,J( By Initial: �Ql EHD 28-01 L 01/16/08