Laserfiche WebLink
i • 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 /> �D M S Pager °f <br /> Facility Address: City: Inspectio Date: <br /> c �z� �� fscfiGD al <br /> FA#: PR M Program Element: <br /> a16--so //-- <br /> Zgsd <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 11,320 gallons in tanks'and containers", <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 1 Total Capacity: 1 O Q !Q gallons Product Type: �rfb <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) El Containers (2821) <br /> #of Containers: _y TAR: O�IGIa f:C <br /> 2 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 /> 3 Product Type: O.i P <br /> Total Capacity: L08 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: 10" gallons r <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 5 Total Capacity: y 01YO gallons Product Type: LL9 ) <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: �� (� gallons Total Capacity for Site: gallons <br /> Comments: �l UlJaUeJ <br /> EHD Inspector: Reviewed Date: Entered Dateb: <br /> By Initial: �,��- By Initial: l <br /> 'Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. <br /> "Container means a storage device designed to be moved when full. <br /> EHD 28-01 AST SURVEY FORM <br /> 09/12/08 <br />