Laserfiche WebLink
SAN JOAOUIN 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: Page / of <br /> City: <br /> Inspeytjoe� r} <br /> Facility Address: <br /> d VV u Program Element: <br /> FA M. PR#: <br /> gra <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 /> ❑ ank (2820) ❑Containers (2821) #of Containers: Ty: <br /> 1 Product Type:' <br /> Total Capacity: gallons <br /> F (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) ElContainers (2821) #of Containers: TA#: h <br /> 2Total Capacity: Product Type: � d <br /> gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ElTank (2820) ElContainers (2821) #of Containers: TA#: <br /> 3 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 4 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 5 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallonsTotal Capacity:for Site- 0 a gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> By Initial: 44R,oc/ By Initial: <br /> `Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of etroleum. <br /> "*Container means a storage device designed to be moved when full. <br /> EMD 28-01 Ir AST SURVEY FORM <br /> 09/12/08 ^ <br />