Laserfiche WebLink
II <br /> SAN JOAQUIN COUNTY <br /> ' <br /> YNIVIRONMENTAL HEALTH DEPARTMENT <br /> o <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 flax: (209) 468-3433 Web:www.sjgov.org/ehd. <br /> iP <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: Pag' e Of <br /> Facility Add re s: City: Inspection Date: <br /> 1 ,yw y _ o� <br /> FA#: PR#: I Program e <br /> o v <br /> Tank/Container Information <br /> I Complete for ail sites with cumulative aboveground storage of petroleum ?1,320 gallons in tanks'and containers`"'. <br /> Complete one box for each tank or each cumulative container product t e: a <br /> dTank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 1 Product Type: �%�-Total Capacity: gallonsp..�i ---- <br /> (per tank or cumulative for containers by product type) Install Date: E� A F " ' II <br /> I Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 2 Product Type: <br /> Total Capacity: � gallons �J � /� <br /> (per tank or cumulative for con iners by product type) Install Date: �/CS/fl/� <br /> i <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: ! <br /> 3 Product Type: lj <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 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ElTank (2820) ElContainers (2821) #of Containers: TA#: <br /> 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: !3 <br /> Total Capacity this Page: j,�tl� gallons Total Capacity for Site: a gallons <br /> Comments: C � <br /> n <br /> o / <br /> EHD Inspector: Reviewed Dale: Entered Date: <br /> Cr By Initial: to.C(. 8y Initial: �i <br /> }Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of'petroleum. r ' <br /> "*Container means a storage device designed to be moved when full. <br /> EHD 28-01 i AST SURVEY FORM <br /> 09112108 i 1 <br />