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SAN JOAQUIN COUNTY 0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 029 <br /> Telephone: (209)468-3420 Fax. (209)468-3433 Web:Www .sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM'STORAGE PROGRAM SURVEY FORM <br /> Fa ty Name: <br /> 0 z� Page o <br /> Fa ty�re O A a Cityn - Inspection Date: <br /> FAM <br /> CDS VI. tai PRr 1 <br /> 2 Pro rem Elem Int: <br /> 7 <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) #of Containers: 5 TA#: <br /> 1 Product Type: '1 <br /> Total Capacity: 02� gallons <br /> (per tank or cumulativeforoontainers by product type) <br /> Install Date: <br /> ❑ Tank (2820) containers (2821) #of Containers: a TA#: _BcS�2/9�RP� <br /> 2 Total Capacity: 0 gallons Product Type: IN .Si (T) <br /> (per tank or cumulefiveforwntainers by product type) `pvl% (✓� �� �t�pro`O.QSSr2 Q-W( <br /> Install Date: <br /> ❑ Tank (2820) C containers (2821) #of Containers: TA#I: fi,,5';Q ��?! <br /> 3 Total Capacity: —iLL-gallons Product Type: Y� t t N <br /> (per tank or cumulative for wntalners by product type) Install Date: owfAWd <br /> 0'l <br /> ❑ Tank (2820) eaContainers (2821) #of Containers: a TA#I: NcS62Wo22cZ <br /> 4 Product Type: <br /> Total Capacity: _ ( t () gallons <br /> (per tank or cumulative for containers by producttyp`) (0'Lld,/� Byt,Q�,�rfY <br /> Install Date: <br /> ❑ Tank (2820) /l5 Containers (2821) #of Containers: TA#: iR4o2B�� <br /> 5 Total Capacity: v gallons Product Type: 01 2— — <br /> (per tank or cumulative for conlialners by product type) <br /> Install Date: <br /> Total Capacity this Page: O� gallons Total Capacity f r SI 32-17 gallo <br /> ks <br /> Comments: <br /> EHD Inspector: Reviewed Date: Entered <br /> :aL6601 tt By Initial: By Initial: Date: `J <br /> *Aboveground storage tank means 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 26.01 <br /> 09/12/06 AST SURVEY FORM <br />