BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTM. 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: �� `!//✓� e�_'j —r7lel /ey d Page of Facility Address: City: Inspectioq Da)e: �l v FA #: PR #: Program Element: oC V Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum >_ 1320 gallons in tanks and containers over 55 gallons. Co Tete one box for each tank or each cumulative container product type. ❑ Tank (2820) Containers (2821) #of Containers: A#: 5 4, 1 (>250 gallons) (>55 gallons and <250 gallons) Product Type: Total Capacity: 7.J 0 gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) Containers (2821) #of Containers: 2f (>250 gallons) (>55 gallons and <250 gallons) Product Type: Total Capacity: rj gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) EeContainers (2821) #of Containers: Z' TA#: q & 3 (>250 gallons) (>55 gallons and <250 gallons) Product Type: Total Capacity: //0 gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) containers (2821) #of Containers: TA#: JwP3 4 (>250 gallons) (>55 gallons and <250 gallons) Product Type: Total Capacity: L/0 gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) Containers (2821) #of Containers: TA#: 5 (>250 gallons) (>55 gallons and <250 gallons) Product Type: Total Capacity: // U gallons Install Date: (per tank or cumulative for containers by product type) Total Capacity this Page: % gallons Total Capacity for Site: gallons Comments: EHD Inspector: Reviewed Date: Entered Date: By Initial: By Initial EHD 28-01 01/16/08