Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> is/ ENVIRONMENTAL HEALTH DEPARTMEN <br /> ` 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Na <br /> A 1V1Page of <br /> Facility Address: Cit <br /> / 7- 71 C N r y _ T/� Inspection <br /> FA#: / >� PR#: Program Element: <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) ^ - <br /> 1 Product Type: r>-[q-C / <br /> Total Capacity: s'oT/ gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> R?' ank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2Product Type: <br /> Total Capacity: ,SOO gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: .� (,�C70 gallons I Total Capacity for Site: O (7 a gallons <br /> Comments: l j '/ I 5. cf4 <br /> S ETNO ol= Ro <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> C ` By Initial: `a.�•t)� By Initial: <br /> EHD 28-01 7 <br /> 01/16/08 <br />