BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209)468-3420 Fax: (209) 468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: AiAANr IE_ � ✓V�� Page - of 'z� Facility Address: n City: Inspection Date: A FA#: PR M Program Element: > i Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks`and containers". Complete one box for each tank or each cumulative container product type. i)Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Total Capacity: 1 �� gallons Product Type: tX 6, � rec (14 d (per tank or cumulative for containers by product type) Install Date: ' Tank (2820) ❑ Containers (2821) #of Containers: TA#: p o _ 2Product Type: L�h-� Total Capacity: �(;J gallons vs (per tank or cumulative for containers by product type) Install Date: �4 Tank (2820) ❑ Containers (2821) #of Containers: TAi#: b)c-) q w 3 " Product Type: Total Capacity: Z) gallons (per tank or cumulative for containers by product type) Install Date: N:,'Tank (2820) El Containers (2821) #of Containers: TAr#: _ p 16 1 g o 4 Total Capacity: _ Product Type: j gallons (per tank or cumulative for containers by product type) Install Date: 19 Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Product Type: Total Capacity: 'U gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 12 gallons Total Capacity for Site: f? gallons Comments: EHD Inspector: Reviewed Date: Entered Date: By Initial �.�.l 0 By Initial: "Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. "Container means a storage device designed to be moved when full. EHD 28-01 09/12/08 AST SURVEY FORM