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• ua,iti.;�OA3�UI'i C*JYJi`1TY <br /> ' �WWEiJV!kONMENTAL HEALTH DEPARrMENNW� <br /> 600 East Plain Street, Stockton,CA 95202-3029 <br /> Telephone: (209)468-3420 Fax:(209'1468-3433 Wetr:www.sjgov.org)ehd <br /> ABOVEGROUIND PETROLEUM STORAGE PROGRAM SURVEY POS <br /> Facility x !/Z> ivollS eIepa.C'f/D� /:S TRS TE-f Page L_of <br /> City. Ins ectio Datel <br /> Facility Address: <br /> z 9 2/ <br /> FIR#:aJ ` ProgreZElement: <br /> Tank/Container Information R t,40 <br /> Complete for all sites with cumulative aboveground storage of petroleum >_1320 gallons in tanks and containers over 55 gallons. <br /> Com Tete 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: <br /> Total Capacity: —S-0-0gallons Install Date: <br /> (per tank or cumulative for containers by product type) [ <br /> i <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: _ <br /> b250gallonsi (>55 Ions and20_ —)!' <br /> 2 Product Tripe: ;. <br /> Total Capacity: gallons <br /> Install Date: <br /> (per tad:or cumulative for containers by product type) " <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: — <br /> Totai Capacity: gallons Install Date: <br /> (per tank or cumulative for eontalners by product type) <br /> ❑ Tank (2820; ❑ Containers (2821) #O'Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> Product Type: <br /> i��ral Ca�aClt•L �all9^° <br /> 1aJta11 Jazti.: <br /> :,pA;;lnk ur eumll!n.i'/e:Gi CJinatl16�5 by pCGfiUCI tvpC) j <br /> ❑ Tar-k (2820) ❑ Containers (282 i) r;of Containers: T A#: <br /> 250 gal!ors; (>S.ga!!rns and Q50 gallons) <br /> j aroduct .yr;, -- — — <br /> �� -- <br /> i•y-•r. .-"se:fa. -.r. ,r:•�r ': � .:5 c ., ol..,. .,u.�. _ .- — - <br /> v-a <br /> •�Jii',tIlciiu: <br /> 1 <br /> G �320 <br /> '1 <br /> EHD Inspector. Reviewed Date: / En[ercd ) Date: <br /> . � By Initial t2,.k-v By Initial: 1/ /�/ <br /> EFID 23-01 """VVV t--'C--�- <br /> 01 16.03 <br />