Laserfiche WebLink
:NVIRONMENTAL HEALTH DEPARTME] <br /> _JO East Main Street, Stockton,CA 95202-362; <br /> Telephone: (209)468-3420 Fax.(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> Page of <br /> Facility Address: City: Inspecti D e: <br /> s T, �` <br /> FA#: PR#: Program Element: <br /> �6I D Zl <br /> -5-__Z1 -,7 <br /> Tank/Container Information <br /> Completefo all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. <br /> ank(2820) ElContainers (2821) #of Containers: TAM <br /> 2/50 <br /> gallons) (>55 gallons and<250 gallons) <br /> 1Z 0 o D Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Cl�Tank(2820) ❑ Containers (2821) #of Containers: TAM g C(1 <br /> (>250 gallons) (>55 gallons and<250 gallons) 1Yv <br /> 2 Product Type: A <br /> Total Capacity: 50 gallons �O <br /> Install Date: <br /> (per tank or cumulative for containers by product type) �1 <br /> ER/Tank(2820) ❑ Containers (2821) #of Containers: TAM r 4 11 vL <br /> - <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: 4,v/Q f <br /> Total Capacity: 9,�70 gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for coma' y product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: ` gallons Total Capacity for Site: , C7 C) gallons <br /> Comments: <br /> U <br /> L�N <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> By Initial: (0,,`1--pBy Initial: [L <br /> EHD 28-01 <br /> 01/16/08 <br />