BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY,i ENVIRONMENTAL HEALTH DEPARTMENT - 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209)468-3433 Web:www.sjgov.org/ehd 3 ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: C- Page of Facility A dres : o City: Inspectiop Date:j -2, z s� �� ,v r ,> FA#: PR M FrogrAirin Elem nt: 6 7 A63 g5 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum X1,320 gallons in tanks*and containers", Complete one box for each tank or each cumulative container product type. Tank (2820) C3Containers (2821) #of Containers: TA#: 1 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) 11Containers (2821) #of Containers: TA#: 2 Total Capacity: 2Y D gallons Product Type: p Y• (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM 3 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: .s ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ElTank (2820) 11Containers (2821) #vf Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: gallons Comments: { EHD Inspector: Reviewed Date: Entered Date: { By Initial: �_l°�j By Initial: "Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. "Container means a storage device designed to be moved when full. EHO 28-01 d AST SURVEY FORM 09112/08 ll;