BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY YNVIRONMENTAL 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: A , U Page of Facility Address: City: Inspects n Date• a 222 o IV )l (�k 2. 8 0/Q FA M. PR#: Program Element. Tank/Container information Complete for all sites with cumulative aboveground storage of petroleum X1,320 gallons in tanks*and containers**. Complete one box for each tank or each cumulative container product type. rank (2820) ❑ Containers (2821) .#of Containers: TA#: 1 Total Capacity: Gt�7 gallons Product Type: (per tank or cumulative for containers by product type) install Date: CLl a k (2820) ❑ Containers (2821) #of Containers: TA#: 2 Total Capacity: �� gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Tank (2820) 11Containers (2821) #o#Containers: TA#: I/ 3 Product Type: r-191 Z7 Total Capacity: 72_,yPLzq gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ElTank (2820) 11Containers (2821) #o#Containers:. TA#: S1 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: / gallons Total Capacity for Site: gallons Comments: EHD Inspector: (� Reviewed Date: Entered Date: V By Initial: ?-31,0°' 6y Initial: g' *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. **Container means a storage device designed to be moved when full: EHD 28-01 r AST SURVEY FORM 09112/08