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: • / S � "�" �% �- � C) /VS Page of Facility Address: City: Inspec ' Date: h� LTR /� Ur G z ��o FA #: / PR M Program Element: P Z $3 0 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. 12/'Tank(2820) ❑ Containers (2821) #of Containers: _ TA#: 1 Total Capacity: D-ct—o gallons Product Type: ,t -te'adj (per tank or cumulative for oMainers by product type) Install Date: U3 Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Total Capacity: a gallons Product Type: D/ / S� (per tank or cumulative for containers By product type) Install Date: l� /tier TY 12/Tank(2820) ❑ Containers (2821) #of Containers: TA#: 3 Total Capacity: / � gallons Product Type: 6:4S 7 (per tank or cumulative for containers by product type) Install Date: E�zr/ ❑ Tank (2820) o4/containers (2821) #of Containers: TA#: 4 Total Capacity: � � gallons Product Type: 4? q7Dr', D ° (per tank or cumulative for containers by product type) Install Date: El Tank (2820) Containers (2821) #of Containers: % TA#: ;SI 5 Total Capacity: gallons Product Type: %< ��C.aS�i�✓� (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total )Capacity for Site: gallons Comments: xj�/ �ZLr. /; F6: � e� J EHD Inspector: Reviewed Date: By Initial: l� -� d� Entered Date: By Initial: lliLj "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