Laserfiche WebLink
U <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,"Stockton, CA 95202-3029 <br /> E <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: 11 <br /> /= Z,1 �1a Page <br /> i <br /> r <br /> 4 Facility Address: City: Ins77�� <br /> r / S-/ <br /> FA#: PR M. Program Eleme t: <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks"and containers". <br /> Complete one box for each tank.or each cumulative container product type. <br /> Tank (2820) El Containers (2821) <br /> #of Containers: TA#: <br /> 1 <br /> Total Capacity: �-4z© gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br />, <br /> EJ Tank (2820) El Containers (2821) <br /> #of Containers: TA#: <br /> 2 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 /> 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 /> 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 /> 5 Total Capacity: galions Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHp Inspector: Reviewed Date: .�p ,,p,� Entered Date: <br /> By Initial: WN �`Q`t V I By initial: VOs 7 <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 /> 09/12108 <br />