Laserfiche WebLink
0 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 />Facility Name: <br />Page of <br />Facility Address:� cl <br />Inspection Date; <br />-57! <br />" � <br />`Z <br />FA #: <br />339 <br />PR #: <br />- <br />Program Element: <br />-2- <br />yTank/Container <br />Tank/ContainerInformation <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 product type. <br />IP/Tank (2820) ElContainers (2821) #of Containers: TA#:Gj / q <br />1Product <br />Total Capacity: % (�� C? C� gallons Type: <br />(per tank or cumulative for containers by product type) Install Date: <br />ET Tank (2820) ❑ Containers (2821) #of Containers: TA#: (2,5:/13 lNo <br />2 <br />1 <br />Total Capacity: > (�� Product Type: <br />(per tank or cumulative for containers by product type) Install Date: <br />El Tank(2820) CYContainers (2821) #of Containers: TA#: q )3'7 <br />3 <br />Total Capacity:/ (? gallons Product Type: /2j� TO& 0 s �% <br />(per tank or cumulative for containers by product type) Install Date: <br />❑ Tank (2820) Containers (2821) #of Containers: TA#: <br />4 <br />Product Type: 0 � <br />Total Capacity: - _ gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />© Tank (2820) 1:1Containers (2821) #of Containers: TA#: d <br />5 <br />Product Type: rY� S �� <br />Total Capacity: gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />Total Capacity this Page gallons <br />Total Capacity for Site: �/ gallons <br />Comments: <br />EHD Inspector: <br />Reviewed Date: <br />By Initial: � �.�1-Q <br />Entered Date, <br />By Initial: (Cly <br />Aboveground storage tank means a tank tnat nas the capacity to store 55 gallons or more of betroleum. / <br />"Container means a storage device designed to be moved when full. <br />EHD 28-01 AST SURVEY FORM <br />09/12/08 <br />