BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMEN-L lv- '- .600 East Main Street,Stockton,CA 95202-302 - Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/chd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: . f- se/r(C/1 Page of f Facility Address: City: Inspectio Date: ! FA#: i PR#: Program Element/: 4//du Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum z 1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. E"fank(2820) ❑ Containers,(2821) #ofContainers: r - TA#: (>250 gallons) (i55 gallons and<250 gallons) 1 'Product.Type: 4ri,Z75` 7-e a/ Total Capacity: 2- d gallons (per tank or cumulative for containers by product type) Install Date:. Tank (2820) ❑ Containers (2821) #of Containers: V TA#: (>250 gallons) (>55 gallons and<250 gallons) . 2 _ Product Type: /42 t2 T-a YI Total Capacity: '� gallons "r©' (per tank or cumulative-�.,a cunramers by product type) Install Date: Tank (2820) �ontaineis (282 1) #of Container a�- TAM (>250 gallons) W-""•5 gallons and<250_eallons) ' 3 « > y w Product Type: l� J Total Capacity: gallons (per tank or cumulative for contai' _,vnoduct type) "Install Date: ❑ Tank(2820) = writainers V821) #of Containers: TA#: } (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers.(282 1) .#of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers byproduct type) Install Date' Total Capacity this Page: gallons Total Capacity for Site: gallons Comore Az A? -A s S EHD Inspector: Reviewed Date: Entered Date: r By Initial: vv" 61_l�_6� By Initial:L EHD 28-01 01/16/08 ij