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: �� y� 1 -Ad , - 0 1� �ti�( Page � of Facility Address: VkB_47 City: Inspection Date: n� � !i �t LA q_, !-I`�(J C"-i� /t FA#; PR M Program Element: 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. IT)Tank (2820) ❑ Containers (2821) #of Containers: TA#: 11 Product Type: Total Capacity: .7 L) gallons (per tank or cumulative for co tainers by product type) Install Date: V Tank (2820) ❑ Containers (2821) #of Containers: /) TA#: Z 1�,:3 a' 2Product Type: Total Capacity: �� gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: I 15s() gallons TTotal Capacity for Site: ''Z gallons Comments: EHD Inspector: Aq;), ^ k r Reviewed Date: Entered f Date: /lll/// —��\ By Initial: By Initial. � 1 *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