Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEN77 <br /> 00 East Main Street,Stockton,CA 95202-30 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: J / / <br /> La S G G C� `�V D 1 V Page of <br /> Facility Address: City: Inspe . n Datt: <br /> FA#: PR#: Progr m Ele ent: <br /> I( L9 - 3 a� <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 /> Com to one box for each tank or each cumulative container product type. <br /> ❑ Tank (2820) EVContainers (2821) #of Containers: TA#: /� J <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative fo containers by product type) Install Date: <br /> ❑ Tank (2820) Containers (2821) #of Containers: TA#: at <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: ! l <br /> Total Capacity: //0 gallons <br /> (per tank or cumulative for containers by product type) Install Date: 'd uatl <br /> ElTank (2820) 2"Containers (2821) #of Containers: �� TA#: �— <br /> (>250 gallons) (>55 gallons and Q50 gallons) <br /> 3 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cuulative for containers by product type) Install Date: <br /> m <br /> ❑ Tank (2820) W Containers (282 1) #of Containers: 7/ TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: e / Q f <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: al.d (/ t <br /> � I <br /> L <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and 50 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: All <br /> gallons Total Ca aci for Site: <br /> v g P ty 6 v gallons <br /> Comments: <br /> � 1 <br /> 1 - <br /> EHD Inspector: Reviewed Date: Entered I 1 Date: <br /> C ` By Initial: By Initial: -r/J <br /> EHD 2M I <br /> 01/l6/08 <br />