BILLING - Laserfiche WebLink

Home Browse Search

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: p C /qIA Page j— of Facility Address: , City: Inspect n Date: FA #: PR #: Program Elerygnt: aD -7,1 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 2-1,320 gallons in tanks` and containers". Complete one box for each tank or each cumulative container product type. C�/Tank (2820) ❑ Containers (2821) #of Containers: T;A#: 0,57cB!2 1 Total Capacity: � (') 0� gallons Product Type: %�,.4c. (per tank or cumulative for containers by product type) Install Date: [J" Tank (2820) ❑ Containers (2821) #of Containers: TA#: 0,6--)$Q 7-3 2 Total Capacity: � gallons Product Type: T� S per tank or cumulative for�ners by product type) Install Date: - Tank (2820) l� Containe (2821) #of Contain rs: TX#: �� 1 g'�' 1 --Total Capacity: - � gallons Product Type: w� S D i (per tank or cumulative for containers by product type) Install Date: LTJ Tank (2820) ❑ Containers (2821) #of Containers: TA#: /g5) 2r-7'7, 4 Total Capacity: -7&) p y: gallons Product Type: 1 ) (per tank or cumulative for containers by 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: 1 gallons Total Capacity for Site: gallons Comments: EHD Inspector: /n L j "A L_..__.__..�J __ _ _ _ Reviewed By Initial: Date: .a �- Entered Date: By Initial: Aboveg�ouna 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