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SAN JOAQUIN COUNTY <br /> OEWIRONMENTAL HEALTH DEPARTMENA <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fox.(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: �^ / <br /> l- �C� v �- -F N Page of <br /> Facility Address: City: Inspec[i n?Da[ <br /> 08 <br /> FA#: PR#: K Program Element: <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. <br /> ❑ Tank(2820) kContainers (2821) #of Containers: TA#: 251 q'0 y' <br /> (>250 gallons) (>55 gallons and<250 gallons) --� <br /> a' Product Type: f-+& C kXorl (U(J(-p lab <br /> Total Capacity: �_gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> IX Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and Q50 gallons) <br /> Z Product Type: r' Its u✓�_ ,( <br /> Total Capacit gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> [ r <br /> (>250 gallons) (>55 gallons and Q50 gallons) <br /> t� /O1 d'00 Product Type: N'14 <br /> L <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 /> (>250 gallons) (>55 gallons and<50 gallons) <br /> Product Type: Ll. <br /> Total Capacity: UD gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: a5j h 'S3 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> Product Type: >5`( ¢Sem. <br /> Total Capacity: I S 1000 gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> Total Capacity this Page: LlD gallons Total Capacity for Site: Q gallons <br /> f <br /> ments: <br /> spector: Reviewed Date: Entered Date: <br /> By Initial: 16- By Initial: <br /> 1 <br />