BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

SAN JOAQUTCOUNTY 'n ENVIRONMENTAL HEALTH DEPARTMEN'� Dy✓ i600 East Main Street,Stockton,CA 95202-302_/ C Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.orglehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: ,A�// M 14M 1�/V l ' � � !/ / 16'P/7— t Dlpj° Page of Facility Address: City: Inspec a Date- 17 9 o G� - N 2T'-5 Gv J T�' o - e FA#: /tt PR �/��D/ ram EI e qp T Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. Com tete one box for each tank or each cumulative container product ❑ Tank(2820) ±Containers (2821) #of Containers: TA#: I (>250 gallons) (>55 gallons and<250 gallons) Product Type: _ (/'d//Cx 0< Total Capacity: S S gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank(2820) eContainers (2821) #of Containers: / TAM 2 (>250 gallons) (>55 gallons and<250 gallons) Product Type: ✓ K �/� C ro / b- Total Capacity: Z S C) gallons Install Date: (per tank or cumulative for containers by product type) -- Tank(2820) ❑ Containers(2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: B/ Total Capacity: �U 0gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers(2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date' _ Total Capacity this Page: gallons 'Total Capacity for Site: 0 gallons Comments: 2rj A 6 EHD Inspector: IQ Reviewed Date: Entered Date: By Initial: By Initial: EHD 28-01 01/16/08