Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> 4 I4,NVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Weh:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> !til co (j Page � <br /> T — of <br /> Facility Address: City: Inspection D te: <br /> 4 <br /> FA PR# Program lement: <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum z 1320 gallons in tanks and containers over 55 gallons. <br /> Com Tete one box for each tank or each cumulative container product e. <br /> ❑ Tank (2820) Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: 7J"'? Z7' <br /> Total Capacity: 0 gallons <br /> (per tank or cumulative for-containers;by product type) Install Date: <br /> ❑ Tank(2820) P-60'ntainers (2821) #of Containers: 2/ TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) �f <br /> 2 r jD Product Type: <br /> Total Capacity: 1 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) QYContainers (2821) #of Containers: 'Z TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: �0 Lf VAF Ai <br /> Total Capacity: ����, gallons "— <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: Entered ] �J Date: <br /> By initial: By Initial: /✓ Y <br /> e Lam/ <br /> EHD 28-01 <br /> 01/16/08 <br />