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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTME1 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: .Sov SAS G U T'D ni /e, SII Page__L of Facility Address: City: Inspecti n Dat . �Qr��niGT o"� �'��o Q FA#: PR#: Program Element Da �o�$Z SZ-3 � �1 2g3 � Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum >_1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. Tank (2820) ❑ Containers (2821) #of Containers: TA#: D5144 31:39 (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: Total Capacity: /0 , o 4-0 gallons (per tank or cumulative for tamers by product type) Install Date: kT Tank (2820) ❑ Containers (2821) #of Containers: TAM (>250 gallons) (>55 gallons and<250 gallons) Z Product Type: Total Capacity: S C� � gallons (per tank or cumulative for containers by product type) Install Date: ank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: Total Capacity:SO 0 gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: ^C9 a gallons Comments: EHD Inspector: Reviewed Date: / Entered Date; By Initial: S . L7'0`6 By Initial: (rp EHD 28-01 01/16/08