BILLING - Laserfiche WebLink

Home Browse Search

SAWIOAQUIN 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 --y nana. - ��DiM Pageof Facility Address: City: Inspection Date: 311 FA #: PR #: e -A oo i 12-2 5 Program Element: �Pp 2$3 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 co tainer product type. I Tank (2820) ❑ Containers (2821) #of Containers: TA#: [4c3 1 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: 1, Tank (2820) ❑ Containers (2821) #of Containers: 3 Total Capacity: � e" C, gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#:_ 4 Total Capacity: �- �. gallons S Product Type: e— (per tank or cumulative for containers by product type) ElTank (2820) *ontainers (2821) Install Date: #of Containers: 1 �' TA#: Product Type I' �� 5 Total Capacity:__ gallons (per tank or cumulative for containers by f educt type) Install Date: Total Capacity this Page: '%l. /, gallons Total Capacity for Site:Z� gallons Comments: EHD Inspecto : Reviewed Date: By Initial: y , �� ,,� Entered Date: By Initial: r%uwCyiuuno srorage ia(tweans 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 09/12/08 AST SURVEY FORM