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SAN JOAQUIN COUNTY 0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> ABOVEGROUND PETROLEUM'STORAGE PROGRAM SURVEY FORM.. <br /> Facility Name: GG .. <br /> nt 02( � Page o <br /> Facility Address: DI <br /> Inc ction Date: <br /> FA#: PR aff: <br /> Program Element: <br /> Tank/Container Information a + <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks*and containers"*. <br /> Com fete one box fo tank or each cumulative container product tvPe. <br /> ❑ Tank (2820) Containers (2821) #of Containers: Ln /�TpA#: �, o�D <br /> 1 Total Capacity: �gallons Product Type: l elf d <br /> (per tank or cumulative for containers by product typo) , <br /> Install Date: <br /> F(op,rTtlnk <br /> ank (2820) Containers (2821 #of Containers: t TA#: 19.S qp R6' <br /> 2 Capacity: gallons Product Type: <br /> or cumulative for wntai ra by product type) Install Date: <br /> E) Tank (2820) Q Containers (2821 #of Containers: TAM ��aoa <br /> 3 Total Capacity: gallons Product Type: 0 ton <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 4 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulaflvefor containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 5 Total Capacity: gallons Product Type: <br /> (per tank or cumulstivefor contalners by product type) Install Date: <br /> Total Capacity this Page: :3-30gallonsTotal Capacity for Site: Ballo <br /> Comments: <br /> EHD Ins-p.�{�ct—tor: Reviewed Date: Entered Date: <br /> By Initial: 1 By Initial: /_ p <br /> *Aboveground storage tank means a tank that has the capacity to store 55 gallons e roleum.�or more of pc [ <br /> "Container means a storage device designed to be moved when full. <br /> EHD 2B-01 <br /> 09/12/08 AST SURVEY FORM <br />