Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL.HEALTH DEPARTMENT <br /> I 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)468-3433 Web:www.sjgov.orglehd <br /> ABOVEGROUND PETROLEUM.STORAGE PROGRAM SURVEY FORM <br /> Facility Name: —� <br /> 4 !✓S. S Page of <br /> Facility Address: city: Inspectibn Date: <br /> FA#: PR#: Program e <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks and containers". <br /> Com tete one box for each tank or each cumulative container producttype. <br /> VTank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 1 Total Capacity: -7 " gallons Product Type: _4 <br /> (per tank or cumulative for containers by product type) Install Date: <br /> EI'Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 2y: r <br /> Total Capacity: S'l _gallons Product Type: <br /> (per tank or cumulative for containers 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 /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 4 Product Type: <br /> Total Capacity: gallons <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: b gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: Entered <br /> By Initial: By 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 /> 09112108 <br />