BILLING - Laserfiche WebLink

Home Browse Search

t r SAN JOAQUIN COUNTY 0 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: rr O C/ Page L of Facility Address: City: Inspe tion 3. O FA#: PR#: r Prog�AIq 077lk Tank/Container Information l/ b (/ 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. D Tank (2820) ❑ Containers (2821) #of Containers: TA#: 06/'7833 Total Capacity: 'tC�7 Product Type: YPe: (per tank or cumulative for containers by product type) Install Date: 9 'Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: C9-'7ank (2820) ❑ Containers (2821) #of Containers: TA#: L961 7� 3 Product Type: Total Capacity: �� gallons (per tank or cumulative for containers by product type) Install Date: tank (2820) ❑ Containers (2821) *of Containers: TA#: 4 Total Capacity: r, gallons Product Type: (per tank or cumulative for containers by product type) Install Date: wank (2820) ❑ Containers (2821) #of Containers: TA#: /Q6-1_`75k 5Total Ca acit �! Product Type: P y: � _ _gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 2 So 0 d gallons Total Capacity for Site: 3 gallons Comments: EHD Inspector: 1 Reviewed Date: Entered Date: By Initial: -a ,S-6 1 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