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SAN JOAQUIN COUNTY <br /> • ENVIRONMENTAL HEALTHDEPARTMEI <br /> 600 East Main Street,Stockton,CA 95202-3 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sigov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: i <br /> p H Wllvly 'rfi U r- k4! Page of -- <br /> Facility Address: City: Inspection D te: <br /> 2- 567 Ft M A/VG 0 6 / <br /> FA#: PR#: P ogramlement: <br /> 00 / z / 9 26 9a/ 2Rz- <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum z 1320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. <br /> P'f;nk(2820) ❑ Containers (2821) #of ntainers: TA#: <br /> (>250 gallons) (>55 gallons and<50 gallons) <br /> 1 <br /> Total Capacity: / 2-o v a <br /> gaUeas— <br /> (per tank or cumulativ �� y product type) Install Date: <br /> ❑ Tank(2820) 1P Containers (2821) #of ontainers: j T <br /> 2 (>250 gallons) (>55 gallons and<250 gallons) e: 7F <br /> Total Capacity: 5- <br /> (per tank or cumulative y product type) Install Date: <br /> ❑ Tank(2820) C3 Containers (2821) #of ontainers: — — $ <br /> (>250 gallons) (>55 gallons and Q50 gallons) <br /> 3 cl <br /> Total Capacity: Install Date: <br /> (per tank or cumulative f y product type) <br /> ❑ Tank(2820) B"Containers (2821) #of ntainers: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 ype: <br /> Total Capacity: `1-0 _gaile <br /> (per tank or cumulative for ,�/r y product type) Install Date: <br /> ❑ Tank(2820) 9 ontainers (2821 #of ontamers: / TA#- <br /> (>250 gallons) (>551 allons and Q50 gado /) <br /> Total Capacity: <br /> (per tank or cumulativ y product type) Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: / v gallons <br /> Comments: „S. x <br /> EHD Inspector: /s Reviewed Dale: Entered Dale. <br /> By Initial: U'b-, By Initial: C/-ems <br /> EHD 28-0I <br /> 01/16/08 <br />