BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY :NVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street,Stockton,CA 95202-302 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/chd ABOVEGROUND PETROLEUM STORAGEPROGRAM M SURVEY FORM Facility Name: C/ Ty Y 0 rI?AGy WAT65 . %!z47rIfi:�Nr GvGG7 Page�of ` Facility Address: City: Inspection Date: q FA Program Element: 0�12' 1CQ�` _ �5�s�a1 z8 �o Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum >I320 gallons in tanks and containers over 55 gallons. — Complete one box for each tank or each cumulative container product type. Tank(2820) '❑ Containers (2821) #of'Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 1 Total Capacity: l t Uy gallons Product Type: (per tank or cumulative for containers by product type) Install Date- 0 ate:❑ Tank(2820) ❑ Containers (2821) #of Containers:, TAM (>250 gallons) (>55 gallons and<250 gallons) 2 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) ❑ 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: ❑ Tark-(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<250 gallons) 5 Product Type: :!Total Capacity: gallons (per tank or cumulative for containers byproduct type) Install Date' Total Capacity this Page:' / O gallons: Total Capacity for Site: `v O O gallons Comments: r t EHD Inspector: Reviewed Date:- Entered Jle D e: _ By Initial: �Cb, By Initial: 14�J' EHD 2M I 01/16/08 I I