BILLING - Laserfiche WebLink

Home Browse Search

r SAN JOAQUIN COUNTYIj ENVIRONMENTAL HEALTH DEPARTMENT: 'T00 East Main Street, Stockton,CA 95202-302 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.orglehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: Page—L—of Facility Address: City: lnspect'on a : FA#: PR#: Progra Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum z 1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. Tank (2820) ❑ Containers (2821) q #of Containers: TA#: " (>250 gallons) (>55 gallons and 450 gallons) --- T_ 1 Product Type: Total Capacity: Sc p gallons (per tank or cumulative for containers by product type) Install Date' ' ❑ Tank(2820) ' ❑ Containers (282 1) #of Containers: : TAM (>250 gallons) .(>55 gallons and 450 gallons) 2 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date' ❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM (>250 gallons) (>55 gallons and 4.50 gallons) 3 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: i ❑ Tank (2820) ❑ Containers (2821) ##of Containers: ' TA#: (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) - ❑ Tank(2820) ❑ Containers (2821) r #of Containers: . TA#: (>250 gallons) (>55 gallons and 450 gallons) 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: E. Totai Capacity this Page.. 17� gallons Total Capacity for Site: ab gallons Comments: EHD Inspector: Y Reviewed Date: Entered Date: By Initiak: 4 t� By Initial: EHD 28-01 ^� v 01/16108