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SAN JOAQUIN COUNTY <br /> INVIRONMENTAL HEALTH DEPAk MENT. <br /> East Main Street,Stockton,CA 95202-302 <br /> Telephone:(209)468-3420 Fdx:(209)468-3433 Web:www.sjgov.org/ehd' <br /> I ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name- fl K page. of <br /> CA City: inspecVnDsFacility AddFA#: PR#: Progrnt: <br /> ril a 3-1 <br /> d) <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 2t1320 gallons in tanks and'containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. <br /> ank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) 0 .0 <br /> 1Product Type: Z4,16 57 , <br /> i Total Capacity: 3 ,j 0 gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> Tank (2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type A410 rg! O >< <br /> Total Capacity: A'0 gallons Install'Date- <br /> (per tan),-.r cumulative for containers by product type) <br /> Tank(2820) Containers (2821) #of Containers: �. TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: <br /> Total Capacl. 'L So iallons Install Date: <br /> (per tank or cumr,. - - , - --- -. ,'r..,.-..-t type) <br /> t <br /> El Tank (2820), El Containers (2821) #of Containers:. TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: <br /> f Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: !� <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date' <br /> Total Capacity this Page: f �� p�. - gallons Total Capacity for Site. /t, 0 gallons <br /> Comments: <br />{ ra G�i✓� .!r✓`A 7�U� <br /> t <br /> EHD Inspector: p Reviewed Date: y� Entered Date: <br /> By Initial: / - -b- U By Initial:+4�% , <br /> l V� <br />{ EHD 28-01 ' <br /> 01/16/08 <br />