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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: (f- n G/ab Ser,�l� a 6'5 Lubes Page / of Facility Address. City: / , Inspection Dater:: I(-J >3 L-i C� C l -2 13 f J o�� ( c�b 2 FA 1{: PR M: ProgrAmElement: 000 " 1 05 033 zz.,4o Tank/Container Information eKa -p -- Complete Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks'and containers". Complete one box for each tank or each cumulative container product type. Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Product Type: /Q E Total Capacity: I ZO gallons (per tank or cumulative for containers by product type) Install Date: 51�Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Product Type: Total Capacity: 12C:> gallons (per tank or cumulative for containers by product type) Install Date: ; "Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Product Type: l J �3 �J 4� o % I Total Capacity: / 20 gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Total Capacity: �O gallons Product Type: C�%--1 —3 o 2 (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Product Type: 3�Total Capacity:Capacity: 1-c) gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: l gallons Comments: EHD Inspector: Reviewed Date: Entered Date: By Initial: -}..�-t) By Inkia1: *Abovegroutid storage tank means a tank that has the capacity to store 55 gallons or mor6 of petroleum. "Container means a storage device designed to be moved when full. EHD 2801 AST SURVEY FORM 09/12/08