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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax:(209) 468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> St. Joseph's Hospital Page -;t of Z- <br /> Facility Address: City: Inspection Date: <br /> 1800 N California Street Stockton Oct 15, 2010 <br /> FA#: PR#: Program Element: <br /> 3761 528692 2832 <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks"and containers". <br /> Complete one box for each tank or each cumulative container product type. <br /> X❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> T' <br /> +Total Capacity: gallons 3,000 Product Type: diesel <br /> (pertank or cumulative for containers by producttype) Install Date: <br /> ❑ Tank (2820) X❑ Containers (2821) #of Containers: 6 TA#: <br /> Total Capacity: 330 gallons Product Type: used oil <br /> [pertank orcumulative forcontamers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 3 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 4 Product Type: <br /> Total Capacity: gallons <br /> (pertank orcumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 5 Product Type: <br /> Total Capacity: gallons <br /> (pertank orcumulative for containers by productlype) Install Date: <br /> Total Capacity this Page: 3,330 gallons Total Capacity for Site: 13,280 gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: ` Entered Date: <br /> j By Initial: 1p,`Ct,�q By Initial: <br /> 'Ablaveg—rqldfid storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. <br /> "Con.�afher means a storage device designed to be moved when full. <br /> EHD 28-01 REV 06/03/10 AST SURVEY FORM <br />