Laserfiche WebLink
SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <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 />Pie A4 /Ya I%in,Q_ vl (SS✓IC. <br />st <br />Page of I <br />Facility Address: City: <br />b l 0— S -f' dcic-f-uv„ <br />J � <br />Inspection Date: <br />—azo Za Pc) <br />FA #: PR #: <br />Program Element: <br />231 <br />Tank/Container Information <br />Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks" and containers". <br />Complete one box for each tank or each cumulative container product type. <br />Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: 9 <br />1 <br />Total Capacity: 'v 22_0 <br />p y: gallons <br />Product Type: <br />(per tank or cumulative for containers by product type) <br />L <br />Install Date: <br />Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: <br />2 <br />N Y0 <br />Total Capacity: � gallons <br />Product Type:y j <br />(per tank or cumulative for containers by product type) <br />Install Date: Uh <br />` t Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: 0 <br />3 <br />Total Capacity: � S� gallons <br />p y: / <br />Product Type: `j SQ C <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />❑ Tank (2820) I Containers (2821) <br />#of Containers: 2 3 TA#: <br />4 <br />Total Capacity: f I d <br />p y: gallons <br />Product Type: a_" uS VVS <br />(per tank or cumulative for containers by product type) <br />Install Date: l y <br />❑ Tank (2820)jContainers (2821) <br />#of Containers: TA#: <br />5�- <br />Total Capacity: Ci gallons <br />Product Type: %\ t{ tila.rs 0 "4 <br />(per tank or cumulative for containers by product type) <br />Install Date: (� <br />Total Capacity this Page: gallons <br />TTotal Capacity for Site: gallons <br />Comments: <br />� u <br />utinQ C h <br />/E,000 M 0-k- �r2 <br />EHD Inspector: <br />Reviewed <br />By Initial: <br />Date: <br />En�red Date: <br />By <br />[ <br />"Above round t k <br />g ora Cl" m s a tank that has the capacity to store 55 gallons or more of petroleum. <br />""Container means a storage device designed to be moved when full. <br />EHD 28-01 <br />09/12/08 AST SURVEY FORM <br />