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SAN JOAQUIN 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 Facility Name: 5'/ L- Ele A Page of Facility Address:city: o ac P-1 Z-1NG Inspection at FA #: PR #: Program Element: J U 1 d <— 5;�D 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 container product type. 21 Tank (2820) ElContainers (2821) #of Containers: TA#: P,6-) �lp1P 1 Total Capacity: gallons Product Type: _/� (per tank or cumulative for containers by product type) Install Date: �nk (2820) ElContainers (2821) #of Containers: TA#- 2 Total Capacity: ��_gallons Product Type: �� (per tank or cumulative for containers by product type) Install Date: 5d' Tank (2820) ❑ Containers (2821) #of Containers: TA#: 05) Ct k 3 r' Total Capacity: 7 gallons Product Type: f (per tank or cumulative for containers by product type) Install Date: C7'Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1J16) (0�% 4 Total Capacity: 7, gallons Product Type: % (per tank or cumulative for containers by product type) Install Date: l tf/Tank(2820) ❑ Containers (2821) #of Containers: TA#: 7,9 5� Total Capacity: S p - gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 3 gallons Total Capacity for Site: 73 70 gallons Comments: Z EHD Inspector: Reviewed By Initial: r Date: ' o- 6- Entered n Date: By Initial: n y * lv` 9 D Aboveground storage tank means 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 AST SURVEY FORM 09/12/08/08