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7 <br /> SAN.10AQUIN COUNTY <br /> � ENVIRONMENTAL HEALTH DEPARTMENT <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 /> Facility Name: <br /> 0d f�VZ- ANG p Page of <br /> Facility Address: ity: Inspection Date: <br /> z C) r Lo m_. I-o c�/ all <br /> FA#: PR M Program Element: <br /> � r7 2, C>j` �a �5 -Z F:�v <br /> Tank/Container Infor <br /> Complete for all sites with cumulative aboveground storage of petroleum z1,3Lgallons in tanks*and containers". <br /> Complete one box for each tank or each c mulative contaioduct type. <br /> ❑ Tank (2820) 91 ontainers (2821) #of Cont finers: T!'#: �5[ Sp g: <br /> 1Product Type: _1414 Llw h <br /> Total Capacity: Z/-� gallons <br /> (per tank or cumulative for containers by product type) ---- <br /> Install Date: <br /> ❑ Tank (2820) LR'Containers (2821) #of Containers: TA#: 0,5(173,0 9 <br /> 2Product Type: <br /> Total Capacity: /'/ o gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) LJ-Containers (2821) #of Containers: _ TA#: (q,23 <br /> 3Product Type: %t✓ /S d1 <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) L_K;ontainers (2821) #of Containers: �_ TA#: <br /> 4 J Product Type: Z X C99 <br /> Total Capacity: gallons <br /> (per tank or cumulative for containe s by product type) Install Date: <br /> Tank (2820) El Containers (2821) #of Containers: TA#: /9-l242<3 ' <br /> 5 Product Type: �A Sy/ <br /> Total Capacity: �is gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: 2 C gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> ac By Initial: LA_b-01 By Initial: q <br /> *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. <br /> "Container means a storage device designed to be moved when full. <br /> EHD 28-01 AST SURVEY FORM <br /> 09/12/08 <br />