Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> r 0 ENVIRONMENTAL HEALTH DEPARTME10 <br /> 600 East Main Street, Stockton,CA 95202-3 <br /> Telephone.(209)468-3420 Fax.(209)468-3433 Weh:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> FacI'- Name: 141 r A GVF—Y ✓4/,y <br /> F1i1� �� G� 7 f` (/'� (r Page � of <br /> Facility Address: City: Inspection Date: <br /> FA#: PR#: Program Element:- <br /> 17/ 1 <br /> lement:age <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 /> Co fete one box for each tank or each cumulative container product type. <br /> ❑ Tank(2820) Containers (2821) #of Containers: l TA#: �5 /11e 74,7 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: D I (/ <br /> Total Capacity: / 'Z b gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> /I'ank (2820) ❑ Containers(2821) #of Containers: TAM QS w7�og <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> W <br /> 2 OProduct Type: (T�� <br /> Total Capacity: /� p gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> 2-rtTank(2820) ❑ Containers (2821) #of Containers: TAM ,'5-/(Q 7(oC� <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: 11--41 7—,P •� � <br /> Total Capacity: 3 oy gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank(2820) ❑ Containers (282 1) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 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 /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons <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: <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> By Initial: By Initial: <br /> EHD 28-01 <br /> 01/16/08 <br />