BILLING - Laserfiche WebLink

Home Browse Search

., A SAN.JOAQUIN COUNTY sit 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 of Facility Add ess: r� � �� City: �� InspeV7/ r � / FA M PR#: Progra Element: r �6 9 9 a5 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum X1,320 gallons in tanks*and containers". Complete one box for each tank or each cumulative container product type. W,-rank (2820) ElContainers (2821) #of Containers: TA#: 1 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ank (2820) El Containers (2821) #of Containers: TA#: 2 5- cf7 Total Capacity: gallons Product Type: }moi (per tank or cumulative for containers by product type) Install Date: Tank (2820) C7 Containers (2821) #of Containers: TA#: 3Product Type: Y7 Total Capacity: 3 — Product gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ' ❑ Containers (2821) #of Containers: TA#: 4 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ElContainers (2821) #af Containers: TA#: 8 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: f zi gallons Comments: 6G tn.1r�ZLF } fl , EHD Inspector: Reviewed Date: /� Entered Date: By Initial: V A L� �`�' By Initial: "'Aboveground storage to Bans 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. EHD 28-01 AST SURVEY FORM 09112!08