Laserfiche WebLink
40 SAN JOAQUIN 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: V° �� Jj <br />d'o (j�)r 3t,t ac"i/1 , <br />Page -L of <br />Facility Address: i � ` � �� I City: �� <br />1-� D d r ' <br />Inspection Date: <br />I . / , / zo eny <br />0 <br />- <br />FA #: <br />o� o L1 -4- i <br />PR #: <br />31 1,;?A,.2 <br />Program Element: <br />Tank/Container Information <br />Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks* and containers**. <br />Complete one box for each tank or each cumulative container product type. <br />FS1 Tank (2820) ❑ Containers (2821) #of Containers: I TA#: a._�9L-( �5'?p <br />1 <br />Total Capacity �L gallons Product Type: f5� '�QCcurrl <br />�,. I/ I <br />(per tank or cumulative for con ainers by product type) Install Date: lin f noti l -1 Alt k C ills e <br />❑ Tank (2820) XC ntain rs (2821) #of Containers: 2- TA#: 1Q b l l % I <br />� <br />2 <br />Product Type: L t4 <br />apacity: gallons <br />J�Ft <br />Pper <br />ank or cumulative for co tainers by product type) Install Date: 0'1 k- a& wdl <br />�" <br />#of Containers: TA#: /9, 5-1 q�hr <br />El Tank (2820) J�ontainers (2821) <br />3 <br />Product Type: iYt,P/K1 0 ; 1 <br />Total Capacity: ��(,� gallons <br />(per tank or cumulative for containers by product type) Install Date: 01'1 know ►� <br />` - 5 <br />1:1 Tank(2820) (ontainers (282#of Containers: 3 TA#: <br />1) <br />4 <br />n <br />11Z -( O-0 Product Type: �/� -e <br />Capacity: gallons <br />I <br />Pper <br />/ <br />nk or cumulative for containers by product type) Install Date: _ j / ✓1 1��V�^� <br />'S 't bS tq, + cNt i <br />Tank (2820) containers (2821) #of Containers: TA#: Jr <br />5Product <br />Total Capacity: 1,5-00— gallons Type: � <br />J1 <br />(per tank or cumulative For ontainIers by product type) Install Date: VYl no Wo <br />v7 "Oln{'li O W - <br />Total Capacity this Page:S gallons <br />Total Capacity for Site: gallons <br />Comments: <br />D <br />EHD Inspector: <br />Reviewed Date:1 <br />By Initial:�V L•'1� <br />Entered Date <br />By Initial: 1 <br />"Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. L r <br />**Container means a storage device designed to be moved when full. <br />V <br />EHD 28-01 AST SURVEY FORM <br />09/1?/08 <br />