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: I ' D % / % G - /N G Page of Facility Address: City: Inspectio t Do s `7 o FA #: PR #: �Ro Program Element-- lement--035 035K �3n 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. ❑' Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Product Type: �� 1 P A g Total Capacity: d 00 gallons —� (per tank cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 0 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Product Type: )� Total Capacity: � gallons (per tank or cumulative for containers by product type) Install Date: M/Tank (2820) ❑ Containers (2821) #of Containers: A#: 5 4 Product Type: Total Capacity: gallons 1 (per tank or cumulative for containers by pro uct 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: 2 -Z o gallons Total Capacity for Site: 2 jU gallons Comments: EHD Inspector:/ Cl- Reviewed Date: By Initial: -J Entered Date: By Initial: Vw _6.ock 6 *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