Laserfiche WebLink
~ r SAN JOAQUIN COUNTY <br /> %,oeNVIRONMENTAL HEALTH DEPARTMENT ,.,f <br /> 600 East Main.Street, Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web: www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> s U LIG Lin ��s U% G/T � '' R� i7� Page / of�_ <br /> Facility Address: City: PV w^7 �- Inspection DOC' <br /> � �z� � <br /> FA#: PR#: Program Ell t: <br /> � 91�9 o I-- <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum �:1320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: <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 /> 1>2511 gallons) (>55 gallons and<250 gallons) 4 <br /> 2 Product Type: s <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<250 gallons) <br /> 3 Product Type: <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<250 gallons) <br /> 4 Product Type: <br /> Total Capacity; gallons r <br /> (put tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Pager gallons i Total Capacity for Site: gallons <br /> Comments: <br /> FHD Inspector: FReviewed , . ^� Date: Entered Date: <br /> By Initial: VIA 0$ By Initial: Z �� <br /> EHD 28-01 <br /> Ol/16/08 <br />