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y' ililloW <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTTAEhT <br /> 600 East Main Street, Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web. www.sigov.ore/e <br /> ABOVEGROUND PETROLEUM STORAGE PROq"—k - ft'-1Y FO <br /> Facility Name: U� , /G �0��� Page/Of <br /> ES C ALOE a of N <br /> G Inspection ate- <br /> Facility <br /> Facility Address: S`� �� 1 C L �d V <br /> -L e. G G /FDR . /A VV <br /> Program E ent• <br /> FA#. <br /> DO <br /> Tank/Container Information <br /> Coa for all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. <br /> mp <br /> Complete one box for each tank or each cumulative container prochict type. <br /> Tank (2820) ❑ Containers (2821) #of Containers: T/nJA#: <br /> 1 (>250 gallons) (>55 gallons and<250 gallons) Product Type: .lam <br /> Total Capacity: /00 gallOns Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<50 g°.lnns) <br /> 2 Product Type: <br /> Total Capacity: gallons Install Date: <br /> (per tank 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 /> Total Capacity: gallons Install,t t� Date: I <br /> (per tank or cumulative for containers by product type) I <br /> 1 <br /> El Tank (2820) ❑ CDntainvrc (2821) <br /> (>250 gallons) (>55 gallons and Q50 gallons) 1 <br /> a Product Type: <br /> Total Cap-oityi gallua <br /> CrE I.. <br /> . Sia:-i Date:f par udc nr cutnilutiva fur xi <br /> containers by product C. 1 <br /> I <br /> C] Tan'.; (2320) El Container (2321) #of Containers: TA#: <br /> (>250 gallcm !>55 gallons and<250 gallons) <br /> i Product Type: <br /> T cta up<:ciiy: InsLa" Da.t: <br /> � tomer 2nvv _rinttLt ..mr�rr•.Eir.^r by,^.redut�,^.e) _ —. --- _— - <br /> tl z d SAL - ---- -- <br /> i - <br /> 1 <br /> 1 EHD lnspxtoe Raviewcd Dote- 1 Entered [e:/��/� <br /> � By Initial: 1 f\ 1 'Ura'"/' By Initial: e — <br /> ERD2a-01 <br /> 01116106 <br />