Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> *moll ENVIRONMENTAL HEALTH DEPARTMEN'. <br /> 600 East Main Street,Stockton,CA 45202-302r <br /> Tetephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name' Z l c-� /`!/y�� g l <br /> Tib',q C' --y J'�n pa of <br /> Facility Address: City: Inspectio Date: <br /> rao � <br /> C-aw, G 0 � <br /> FA#: PR#: Program Ele ent <br /> TanidContainer Information <br /> Complete for all sites with cumulative aboveground storage of petroleum z 1320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank(2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (355 gallons and<250 gallons) /–� <br /> i Product Type: <br /> Total Capacity: /D 6; b 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 /> 2 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (282 1) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 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 /> 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 Install Date: <br /> (per tank or cumulative for containers by product type) n <br /> Total Capacity this Page: / 6740 gallons Total Capacity for Site: /�d�(� gallons <br /> Comments: <br /> 3 <br /> EHD Inspector: /p Reviewed Date: &toed Date <br /> (— J By Initial: t �,at( By Initial: <br /> EHD 28-01 <br /> 01/l6/08 <br />