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 />ZWldyr ianK means a tanK that has the capacity to store 55 gallons or more of petroleum. <br />**C her means a storage device designed to be moved when full. <br />EHD 28-01 <br />09/12/08 AST SURVEY FORM <br />e 1] -ee �/ C��? iZ <br />,7` <br />Page of <br />Facility ddress: / , <br />City: <br />Ins ecti n Dat <br />o <br />. fes/ <br />r <br />/✓��/a <br />FA �!. <br />PR #: <br />Program Element: <br />Tank/Container Information <br />Complete for all sites with cumulative aboveground <br />storage of petroleum 21,320 gallons in tanks* and containers'*. <br />Complete one box for each tank or each cumulative container product type. <br />/ <br />Q Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: Q5 j <br />1 <br />Total Capacity: <br />p Y� � � O gallons <br />Product Type: �// <br />(per tank or cumulative for containers by product type) <br />Install Date: / 9z <br />1? Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: a) j <br />2Product <br />Total Capacity: LO�C� gallons <br />Type: Q/ <br />(per tank or cumulative for containers by product type) <br />Install Date: /992 <br />E /Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: <br />3 <br />Total Capacity: 1000 gallons <br />Product Type: <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />T Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: <br />4 <br />Total Capacity: 2 � gallons <br />Product Type: <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />Q" Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: <br />5 <br />Capacity: � 0 <br />Total Y� gallons <br />p <br />Product Type: (0/l/ <br />(per tank or cumulative for containers by product type) <br />Install Date: —/I % Z <br />Total Capacity this Page: SzLI—) <br />gallons Total Capacity for Site: o��4C-1 gallons <br />Comments: <br />EHD Ins or: <br />Reviewed Date: <br />By Initial: <br />td.}t.10tial: <br />:teed Date: <br />jBy <br />ZWldyr ianK means a tanK that has the capacity to store 55 gallons or more of petroleum. <br />**C her means a storage device designed to be moved when full. <br />EHD 28-01 <br />09/12/08 AST SURVEY FORM <br />