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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,CA 95202-307 <br /> Telephone.(209)468-3420 Far:(209)468-3433 Web.www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: '/ <br /> $TA A B L � $ -C O tl7 )91PI <br /> Page � of <br /> Facility Address: City: Inspectio ate- <br /> 12-401 c c_K6,Fo Rv 6 1-16 <br /> FA#: PR#: Program Element: <br /> O 1 .S/J" �/I Z9 31 <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 ete one box for each tank or each cumulative container product <br /> ❑ Tank(2820) Containers (2821) #of Containers: L- TA#: /9,S((p,�/ 7j <br /> (>250 gallons) (>55 gallons and<250 gallons) T <br /> 1 Product Type: �L� �� f� ZT <br /> Total Capacity: 57�r gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) CrContainers( 8�1) #of Containers: TA#: — je5 <br /> (>250 gallons) (>55 gallons and<50 gallons),—, <br /> allons) /p/� !�. O` --- <br /> 2 � Product Typ e: L7 / <br /> Total Capacity: gallons Install Date: <br /> (per tank or cumulative for containers by product type) _ <br /> 11 Tank(2820) CB7 Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: f 6/j�✓H/n <br /> z A <br /> Total Capacity: 1—gallons Install Date: <br /> er tank or cumulative for containers by product type) <br /> ILnk(2820) f!2'Containers (2821) #of Containers: TA#: dJr�ch�ZoZO <br /> (>2 0 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type:�� /(/ ,S <br /> Total Capacity: 5 r gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: 4P <br /> (>250 gallons) (>55 gallons and<250 gallons) _ _, Q, <br /> 5 <br /> Total Capacity: �6 gallons Product Type: � C/ <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: 4 2,O gallonsTotal Capacity for Site: / 2, gallons <br /> Comments: <br /> EMD Inspector: Reviewed Date: u� Entered Dale: <br /> Ci By Initial: wti V By Initial: q <br /> END 28-01 ( Y> <br /> 01/16/08 <br />