Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> • ENVIRONMENTAL HEALTH DEPARTME. <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sigov.org/chd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> Q S b O� Page of <br /> Facility Address City: Ins <br /> CLv F A11A �i <br /> FA#: c2N PR#: if �/ Propra meI/ <br /> ll Tank/Container Information <br /> L'000 <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 /> 41-'fank(2820) ❑ Containers (2821) #of Containers: A#: �`�j J [o Ing(a <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 v p Product Type: l <br /> Total Capacity:l 0 '0 00 <br /> e�w <br /> (per tank or cumulative for containers by product type) Install Date: <br /> W�ank(2820) ❑ Containers (2821) #of Containers: A#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: <br /> Total Capacity: /OO 0 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> 11:31ank(2820) ❑ Containers (2821) #of Containers: TA#: fJ,SI lC InO <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3Product Type: <br /> Total Capacity: '0/' V 0 D gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> 1111 Tank(2820) Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) T� <br /> 4 Zv Product Type: / <br /> Total Capacity: / gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ElTank(2820) 11d'6ontainers (2821) #of Containers: f TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 ZCJ Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: 2 2 gallons Total Capacity for Site: 2 ? 3 �� gallons <br /> Comments: `e <br /> v/v - ,n,✓ r,G� <br /> EHD Inspector: Reviewed 1 Date: Entered Date: <br /> By Initial: t w,nl / _(1/.t>� By Initial: <br /> EHD2MI VVV W <br /> 01/16/08 <br />