Laserfiche WebLink
wtiN 30:QUIN COUNTY �/ <br /> • v EMJIRONMENTALHEALTH DEPARTMEN'ice" <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 /> Facwty?qame:A S C A L O r C/ 7-,y of 0 8/"!G /�f/O/�4�1z S Page—L of <br /> Facility A� -ess: <br /> City: Inspection ate: <br /> C A m LL ' �S-6 C I_or✓ 1 0 2 v 0 <br /> PR#: ' .- Progra n un�o <br /> F.4 e: X <br /> 3a3 0 5a8-�' <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product e. <br /> Tank(2820) ❑ Containers (2821) #of Containers: . TA#' <br /> (>250 gallons) (>55 gallons and X250 gallons) <br /> 1 Product Type: n k On 0 <br /> Total Capacity: 22 gallons Install Date: - <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: __ f <br /> (>250 g*-jInrs) (>55 gallons and<250 gitions) / 1 <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#: j <br /> (>250 gallons) (>55 gallons and 250 gallons) <br /> 3 Product Type: <br /> Total Capacity: gallons <br /> Install Dae: <br /> (per tank or cumulative for containers by product type) - <br /> 1 <br /> )Q2- i n _ roar 7 7 1 ! <br /> i � ❑ ?ank !_,._iJ' ❑ C nta__�_s (_8_l; rofContainers: TA#: j <br /> t (,M gallons) (>55?-Mons and<250 gallons) r I <br /> 1 I Product Type: — <br /> ,- <br /> vvdact 1'27p', uiJta_i llaw. <br /> 4of Containers: TA#: ---- <br /> 1 <br /> 1 - Pr^duCt j 5C — - — _ <br /> i An �a� �.Yr %o �'IQ6� CAmjd� <br /> I <br /> EHD inspector. Reviewed outc:,,ffii Entered Date' <br /> �+ )� By Initial: lb-CA, By Inival: <br /> EHD 281.1 <br /> 01x16/08 <br />