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x , � SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 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: Sb V T A CLAL'12r S Page of Facility Address: City: InspecW24 ate: 3 S5 ,� �; - p FA#. PR#: Program Element: x'73tq,44 3 � Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks*and containers**, Complete one box for each tank or each cumulative container eLoduct type. Tank (2820) ❑ Containers (2821) #of Containers:. TA#: 1 Total Capacity: �0�gallons Product Type: LZA� �- (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2Product Type: Tota! Capacity: � gallons pxlo-�� (per tank or cumulative for c-dhtainers byproduct type) Install Date: ❑ Tank (2820) ❑ Containers (2829) #of Containers: TA#: 3 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: a ❑ Tank (2820) ❑ Containers (2821) #of Containers:-E TA#: 4 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: El Tank (2820) ElContainers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Dater . Total Capacity this Page: U � gallons Total Capa.6ity for Site: gallons Comments: EHD Inspector: Reviewed Date: Entered Date: By Initial: �, _ By Initial: 027 D *Aboveground storage tank means a tank that has the capacity to stare 55 gallons or more of petroleum. t **Container means a storage device designed to be moved when full. t EHD 29-01 AST SURVEY FORM 09,12108 I