Laserfiche WebLink
SAN JOAQUIN 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 />C� ilii.. AI, <br />Abovegruuna storage tanK means a tank that has the capacity to store 55 gallons or more of petroleum. <br />"Container means a storage device designed to be moved when full. <br />ti- <br />EHD 28-01 <br />09/12/08 <br />AST SURVEY FORM <br />III) 12�11 /L <br />Page of <br />Facility Address: <br />City: <br />Inspection Date: <br />FA #: <br />\' <br />PR #: <br />Program Element <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 <br />product type. <br />A� Tank (2820) ❑ Containers (2821) <br />#of Containers: <br />�1 <br />TA#: k SaD <br />1 <br />Total Capacity: gallons <br />Product Type: <br />(per tank or cumulative for containers by product type) <br />Install Date: I <br />'Tank (2820) ❑ Containers (2821) <br />#of Containers: <br />2f <br />- <br />Total Capacity: (, ��, gallons <br />l <br />Product Type: <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />aTank (2820) ❑ Containers (2821) <br />#of Containers: <br />TA#: 1�5 aD `7 <br />3 <br />Total Capacity: , i gallons <br />Product Type: <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />l�0 (.Gt�t l en <br />wank (2820) ❑ Containers (2821) <br />#of Containers: <br />TA#: A),�j 49421 3 <br />4 <br />Total Capacity: gallons <br />Product Type: <br />(per tank or cumulative for container by product type) <br />Install Date: <br />❑ Tank (2820) -E-Containers (2821) <br />#of Containers: TA#: <br />5 <br />Total Capacity: gallons <br />A 0 <br />Product Type: <br />(per tank or cumulative for containe s by product type) <br />Install Date: <br />Lv 6A t <br />sGu� <br />Total Capacity this Page: -LID lb'_� <br />gallons <br />Total Capacity for Site: 7. L gallons <br />Comments: <br />EHD Inspector: <br />r <br />Reviewed f Date: <br />By Initial: QJ F_ O (7,111 <br />Entered Date: <br />By Initial: <br />yF// <br />* A L _ .. _ - _ _ <br />I �� <br />Abovegruuna storage tanK means a tank that has the capacity to store 55 gallons or more of petroleum. <br />"Container means a storage device designed to be moved when full. <br />ti- <br />EHD 28-01 <br />09/12/08 <br />AST SURVEY FORM <br />