BILLING - Laserfiche WebLink

Home Browse Search

}' SAN JOAQUIN COUNTY 3 v. r i ., ;NVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street,Stockton,CA 95202-302 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: C.��diTlat,�' Page:of Facility Address: Cit Inspection Date: 01A�� FA#: ! "f l PR[/ �]OC D� Program ZS Ie�� Tank/Container Informatioln Complete for all sites with cumulative aboveground storage of petroleum L>1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container roduct e. OW"Toank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: �I��- `-• ��17 � _ Total Capacity: S'fl gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (2821) ' #of Containers: TA#,: (>250 gallons) (>55 gallons and<250 gallons) 2 Product Type: . . Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (282 1) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: Total Capacity: gallons. (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 4 � � Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and X250 gallons) - S Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: gallons Comments: EHD Inspector: ReviewedDate: Entered Date, By Initial:' By Initial`. Tf� EHD 28-01 01/16/08