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ti 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: 9 S Page - of / Facility Address: 356 G✓ /�N,r��n/� City: Inspe tion D te: 71Z10) FA #: 03$I PR #: Program Element: zg'�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. Tank (2820) ❑ Containers (2821) #of Containers: TA#: j9,6_1 1 Total Capacity: / -%- i s n gallons Product Type: (per tank or cumulative for containers by product type) Install Date: #of Containers: TA#: 19 1 D� 05/Tank(2820) ❑ Containers (2821) 2 Total Capacity: gallons Product Type:rte- , —T i (per tank or cumulative for containers by product type) Install Date: Tank (2820) El Containers (2821) #of Containers: TA#: �I g� D5� 3 Total Capacity: "� � gallons Product Type: % vim-, � 2�2 � (per tank or cumulative for containers by product type) Install Date: Tom_ /Tank(2820) ❑ Containers (2821) #of Containers: _ _ TA#: $,f? CP 4Product Total Capacity: gallons for Type: (per tank or cumulative containers y product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: �� (� gallons Total Capacity for Site: Z o gallons Comments: EHD Inspector: -7B eviewed Date: By Initial: Entered Date: By Initial: D "Aboveground storage tank means a tank that has the capacity to store 55 gallons or more 6f petroleurrf. `*Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08