Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> � <br /> �1V IRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,CA 195202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Mame: <br /> Al/-A OIML 1-I- - � 1/1-5 S /!v. � Page of <br /> Facility Address: City= � ���� [nsp 0 1]ate: i <br /> ! J g ,ZJ[r <br /> FA#: 7 r PR#: Programle <br /> Tank/Container Information <br /> Comple for all sites with cumulative aboveground storage of petroleum z 1320-gallons,in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product gpe. <br /> Tank(2820) ❑ Containers (2821) #of Containers: p TA <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: <br /> Total Capacity: j 6 O gallons , <br /> (per tank or cumulative for containers by product type) Install Date: <br /> L� <br /> ❑ Tank(2820) Containers (2821) #of Containers: / TA#:" <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: <br /> Total Capacity: Q gallons <br /> (per tank or cumulative for containers byproduct type) Stall 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 Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank (2820)' ❑ Containers (2821) #af Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: <br /> x Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> I <br /> ❑ Tank(2820) ❑ Containers (282.1) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons Install Date: ' <br /> (per tank or cumulative for containers by product type) <br /> Total Capacity this Page: d. gallons Total Capacity for Site: . ! t% gallons <br /> Comments: <br /> 44 <br /> EHD Inspector: Reviewed + Date: Entered Date: <br /> G ` By Initial: By Initial: Q- n <br /> EHD 28-01 <br /> 01/16/08 <br />