Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.orglehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> Page_j of <br /> Facility Address: City: Inspect) n D te: <br /> FA M PR M Program Element: <br /> 7 <br /> ZIT? t'_8 40 <br /> Tank/Container lnformation <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: TA#: <br /> 1 Total Capacity: gallons Product Type: , <br /> (per tank or cumulative for containers by product type) Install ©ate: <br /> C11 ank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 2Product Type: <br /> Total Capacity: gallons - <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 3 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 /> 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 /> 5 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallor s Total Capacity for Site: gallons <br /> Comments: <br /> EHD Insp or: Reviewed Date: Entered Date: <br /> By Initial: , , „f "�.�•0 By Initial: Az Q' <br /> *Abovegrolm rage 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 28-01 AST SURVEY FORM <br /> 09/12/08 <br />