Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
1.i SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <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 Namp- <br /> AN7J! PWY / ,- ^q G//_FPage /-of <br /> Facility Ad�re3 0 ,r �✓ J� City: Inspect Dat4y. <br /> 66 as 7 y p <br /> FA#: / ' i / PR#:D 6 n� Program I e <br /> Op <br /> Tank/Container Information <br /> Complete for ail sites with cumulative aboveground storage of petroleum ?1,320 gallons in tanks'and containers". <br /> Complete one box for each tank or each cumulative container product type. <br /> ank (2820) ❑ #of Containers: TA#:/—Containers (2821) <br /> 1 Total Capacity: 7 97 gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 2 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM <br /> 3 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 4 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 5 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: 0v gallons Total Capacity for Site: J 0 a gallons <br /> Comments: a l <br /> ✓ � / <br /> s r <br /> gs3 <br /> EHD Inspector: Reviewed Date: �Q� Entered Date: <br /> - \ <br /> l By Initial: %-C)- By Initial: 02 11 <br /> *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. <br /> "Container means a storage device designed to be moved when full. <br /> EHD 28-01 AST SURVEY FORM <br /> 09/12/08 <br />