BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

soSAN JOAQUIN COUNTY to 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: Q (0 M9 1, %�J`✓ �� Page of Facility Address: City: Inspection ate: FA #: IMS' PR M I 1�5-303©6� Program Eleme g3 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. Lank (2820) ❑ Cr (2821) #of Containers: TA#: if,5 f S, 751D 1 / ' Total Capacity: D gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Lank (2820) ❑ Containers (2821) #of Containers: TA#: 12,x 23 751 2Product Total Capacity: gallons Type: I� (per tank or cumulative for containers by product type) Install Date: 121' Tank (2820) ❑ Containers (2821) #of Containers: TA#: _ (96 1-26 752- 5 2- 3 3 Total Capacity: ,�C7 Odd gallons Product Type: T� (per tank or cumulative for containers by product type) Install Date: L/ Tank (2820) ❑ Containers (2821) #of Containers: TA#: &u / SS 7 5 4,_ Total Capacity: / �'� gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) Containers (2821) #of Containers: TA#:^l�S 7 5 //(� Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: / Y' P) gallons Total Capacity for Site: gallons Comments: EHD Inspector: Reviewed Date: By Initial: /1-10 Entered Date; a By Initial: 7 1'�? *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