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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: Page —Z— of 9' Facility Address: City: Inspec ion D e: S VA�f A 1.,Lr-A/ �S c_ �9/� FA M PR M Program Element: 572I D z 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. ank (2820) ❑ Containers (2821) #of Containers: TA#: ©51 F67LI 1 Product Type: C/� Total Capacity: / ��o gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ZContainers (2821) #of Containers: TA#: 2Product Type: y/) t�C��iC G ilk I Total Capacity: f_�f gallons (per tank or cumulative for containers by product type) Install Date: El Tank (2820) 2 Containers (2821) #of Containers: TA#: 42 3 Product Type: 070 � Total Capacity: r �7 gallons (per tank or cumulative our P—, •type) Install Date: nk (2820) ❑ Containers (2821) #of Containers: TA#: 4 Product Type: Total Capacity: Z3-0 gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) Q Containers (2821) #of Containers: TA#: 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers byproduct type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: gallons Comments: eq EHD Inspector: Reviewed Date: Entered Date: By Initial: \9.7.71p• By Initial: 7 *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more ofpetroleum. **Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08