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SAN JOAQUIN COUNTY Ah <br /> ENVIRONMENTAL HEALTH DEPARTMENW <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 /> Fat�y Name: <br /> N Page of <br /> I <br /> F cil' less: City; In pection Date: <br /> X160 Chex�l _ l-Aj CA % 6� )-713 <br /> FAN: Fn Sys 11 <br /> In/1 PRN: _ Program Element <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 <br /> type.V/� <br /> Tank(2820) El Containers (2821) #of Containers: TA#: Irt SI7r3i <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 1'v Product Type: Alf <br /> Total Capacity: � gallons '' 11 <br /> (per tank or cumulative for containers by product type) Install Date: (x� oa'o <br /> 0 Tank(2820) ElContainers (2821) #of Containers: TA#: 1/7C}S17 ��1 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Total Capacity: l7/ �� gallons Product Type: BOW - 90 c'j <br /> (per tank or cumulative for containers by product type) Install Date: UNkr'z� <br /> CP Tank(2820) ❑ Containers (2821) #of Containers: TAM TA (SS1aw <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 I" Product Type: �� — L t) o, <br /> Total Capacity: � u gallons <br /> (per tank or cumulative for containers by product type) Install Date: Uvs\wwo` <br /> Containers (2821) #of Containers: e1, <br /> 4 (>250 gallons) (>55 gallons <br /> OI <br /> Total Capacity: ons <br /> (per tank or c containers byproduct type) Install Date: p� r7 <br /> 0 Tank (2820) ❑ Containers (2821) #of Containers: TA#: ` NS-17321 <br /> (>250 gallons) (>55 gallons and<50 gallons) <br /> 5Product Type: �W'eW I <br /> Total Capacity: �Sb gallons �t <br /> (per tank or cumulative for containers by product type) Install Date: UA. !6Na <br /> Total Capacity this Page: -7W gallons I Total Capacity for Site: Q gallons <br /> Comments: <br /> EHD Inspector: /'I —_ Reviewed Da Entered Date: <br /> By Initial: By Initial: CY <br /> EHD2MI 0 <br /> 01/16/08 <br />