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r • 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: Page —L— Of S v'k� 6,bl -F C OW8 Facility Address: City: Ins ctlo Date: g?W ui aA aIud , �{�G(GLill �' �o to FA M PR#: Program Element: 83 Tank/Container Information 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#: i01,5/g9D6- 1 Total Capacity: -r13U gallons Product Type: D I CSC, L "f Z (per tank or cumulative for containers by product type) Install Date: 10156 Tank (2820) ❑ Containers (2821) #of Containers: TA#: 19,,6- 2 ,,2 Total Capacity: DOt� gallons Product Type: (per tank or cumulative for co tamers by product type) Install Date: 1019-6 ❑ Tank (2820) XContainers (2821) #of Containers: 3 TA#: 6,,5-� �153D'T 3Product Type: Total Capacity: 1 (0 S gallons (per tank or cumulative for containers by product type) Install Date: #of Containers: ( TA#: B6-/9 S'"Q� El Tank (2820) X Containers (2821) _ 4 Total Capacity: S�c5 gallons Product Type: We W M D 6� oj'L 15—KD Ki (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) Containers (2821) #of Containers: TA#: DSLq�D q 5Product Type: ��trz�[.�, rU�G "AikLA, Total Capacity: S� gallons (per tank or cumulative for containers by producttype) Install Date: Total Capacity this Page: —2 gallons Total Capacity for Site: D -7 gallons Comments: EFAInspector: rA Reviewed ' A` Date: Entered Date: f/V By Initial: -VA rG A,LO By `Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. "Container means a storage device designed to be moved when full. 'ID 28-01 AST SURVEY FORM '2/08