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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: JJ /� '� `. /q %I /l;r S Pae Of 9 Facility Address: City: �1VD1qA1n� Inspection Da �, vi FA #: l 5 PR M 5�305� Programeft t: �� 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. Ed/Tank (2820) ❑ Containers (2821) #of Containers: TA#: D ' 1 Total Capacity: Pt -e gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: bh / '?,P31 2 Total Capacity: r gallons Product Type: d' 6 12 (per tank or cumulative for containers by product type) Install Date: #of Containers:. TA#: 1�15/Qpc5.2- ❑ Tank (2820) R- ontainers (2821) 3 Total Capacity: gallons Product Type: (per tank or cumulative for containe y product type) Install Date: [1 Tank(2820) L�}'Containers (2821) #of Containers: TA#: O9 1 17 P,13 4 Total Capacity: gallons Product Type: A (per tank or cumulative for co ainers by product type) Install Date: ElTank (2820) Ep Containers (2821) #of Containers: TA#: �S)Ak D`f 5 Total Capacity: � � � gallons Product Type: /'�,%O/Z/' �r (per tank or cumulative for containers by product type) Install Date: Total Capacity this Pag . L� J S gallons Total Capacity for Site: gallons Comments: S- EHD Inspector: _ Reviewed Date: By Initial: �'' Entered Date: By Initial: g a !� *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