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SAN JOAQUIN COUNTY . _4 ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ,a ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: INAgM11fl-DA1't'1 -J--AlqMs Page of� Facility Address: City: Inspe tion D te: 5'09-/-(/kN�2 � ta- FA#: PR M. I rodrWm Eleme 17 `7 3 �8 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks*and containers*". Complete one box for each tank or each cumulative container product type. Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Total Capacity: gallons Product Type: r (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) Containers (2821) *of Containers: T TA#: 2 S Product Type: i?-i O Total Capacity. gallons (per tank or cumulative for-containers by product type) Install Date: ❑ Tank (2820) Mainers (2821) #of Containers: TA#: 3 Product Type: A/k �r of& Total Capacity: gallons (per tank or cumulative for conlai rs by product type) Install Date: '❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 75 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 8 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: 4 gallons Comments: EHD Inspector: Reviewed Date: Entered Date: ,. By initial: V"v -�j�- By Initial: 12 *Aboveground storage taft 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. EHE)28-01 AST SURVEY FORM 09/12/08 El