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SAN JOAQUIN COUNTY ' <br /> lk <br /> K <br /> �`00 <br /> ENVIRONMENTAL HEALTH DEPARTMEN' <br /> East Main Street,Stockton,CA 95202-30 <br /> Telephone:(209)468-3420 Fax:(209)468-3433-Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEYtFORM <br /> Facility Name: Gfi J7?y,x <br /> Page of.� <br /> p <br /> Facility Address: City: G Inspec ton Date: <br /> FA#: T'0� � -1'R 3 t I Programmeet: <br /> S b/ Z if <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 2.1320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. <br /> Gunk(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> I Product Type: <br /> Total Capadity: gallons. <br /> (per tank or cumulative for containers by product type) Install Date: s <br /> VTank (2820) ❑ Containers (2821) #of Containers: TA#: 051 Lp 11V III <br /> (>250 gallons) (>55 gallons and X250 gallons) <br /> 2 Product Type: . 0,/ ;i <br /> Total Capacity: 3 U-D _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 /> a <br /> ❑ Tank (2820) ❑ Containers (282 1) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type':t ,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) 11 = <br /> 5 Product Type: <br /> Total Capacity: gallons = � <br /> Install Date: <br /> (per tank or cumulative for containers by product type) <br /> Total Capacity this Page: gallons FTotal Capacity for Site: gallons <br /> Comments: <br /> /1x19 H�yr�C <br /> EHD Inspector: Reviewed t Entered Date: <br /> • By Initial: S /� By Initial: <br /> EHD 28-01 <br />