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SAN JOAQUIN COUNTY MWNVIRONMENTAL HEALTH DEPARTM 0 East Main Street, Stockton,CA 95202- Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: g J I D D% /VC-, Pae I of J Facility Address: City: Inspecr,19163 n e• 1oZ0 -c, 6 FA#: PR#: Prog m Ele7nt: 00 l v o�� X111-9 '2_ I Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum >_1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. ❑ Tank (2820) VContainers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: S L✓ 3 Total Capacity: Z ,�.O gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) Ly'Containers (2821) #of Containers: TA#: 77 (>250 gallons) (>55 gallons and<250 gallons) T 2 Product Type: a C Total Capacity: Z— �"Q gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) E 'Containers (2821) #of Containers: TA#: L9,--5-f LP7T7 (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: Total Capacity: 2 S`d gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: DJ f 7 g (>250 gallons) (>55 gallons and Q50 gallons) 4 Product Type: /N/J.f Total Capacity: raja gallons (per tank or cumulative for containers by product type) Install Date: Tank(2820) ElContainers (2821) #of Containers: TA#: 4e-7 79 (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: Ir Total Capacity: D 0 gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 7 570 gallons Total Capacity for Site: gallons Comments: ell EHD Inspector: Reviewed Date: / Entered DL7�5+ By Initial: .1,0 tj By Initial: EHD 28-01 01/16/08