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• 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: ' C7 Page _�of Facility Addres . City: Inspection D te: `7 k I5 0 FA#: PR M ProdramElement: 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. k-ITank (2820) ❑ Containers (2821) #of Containers: TA#: 1 � - Product Type: _�Bs_ Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: 'R Tank (2820) ❑ Containers (2821) #of Containers: 'TA#: 2 Total Capacity: j�� gallons Product Type: . (per tank or cumulative for containers by product type) Install Date: � #of Containers: TA#: ElTank (2820) M Containers (2821) 3 ILIA 2 Total Capacity: 10 gallons Product Type: (per tank or cumulative for containers by product type) Install Date:. I ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: _ 4 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: .I h i #of Containers: TA#: ❑ Tank (2820) ❑ Containers (2821) 5 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 �j Q Comments: EHD Inspector: Reviewed Date: Entered Date: ' By Initial: �,�,a By Initial:. *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 , I AST SURVEY FORM 09112108