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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT '''6.00 East Main Street, Stockton,CA 95202-302mwm Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/chd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: X1Pag@ / Of / 50-12 T } L fi A Facility Address: C Inspectio at : g V / may` DCAIN Z73 6 FA#: d O PR#: Program Element: d Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum >_1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product Tank(2820) ❑ Containers (2821) #of Containers: : 17 S 0250 gallons) (>55 gallons and<250 gallons) I Product Type: P _ Total Capacity: Z.500 gallons (per tank or cumulative for containers by product type) Install Date: C�]'Tank (2820) Cl Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 2 Product Type: Total Capacity: /d On gallons Install Date: (per tank or cumulative for containers by product type) Tank 2820 ❑ Containers 2821 ( ) ( ) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: r7e �. Total Capacity: 330 gallons Install Date: (per tank or cumulative for containers by product type) Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 (>250 gallons) (>55 gallons and<250 gallons) Product Type: 1)y qrC (� Total Capacity: 3 o gallons (per tank or cumulative Tor containers by product type) Install Date: EEr/Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: l7 Total Capacity: 'Z—.ra gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: l gallons Comments: r EHD Inspector: Reviewed Date: j Entered Date: By Initial: , A t�b By Initial: LE EHD 28-01 01/16/08