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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: �d J Page of Facility Address: City: Inspec ion D e. ��rrr= Ctq i� j a 9 FA#: P #: f Program EI ment: Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum ?1,320 gallons in tanks`and containers". Complete one box for each tank or each cumulative container product type. ank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Total Capacity: ��L ; o gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ank (2820) ❑ Containers (2821) #of Containers: T,&4'- ij,,45-` 2 Product Type: Total Capacity: �' gallons 42P (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) LTJ Containers (2821) #of Containers: TA#: f�,� /�5�/ 3 Product Type: Avo7al'✓ d/ V Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ank (2820) El Containers (2821) #of Containers: TA#: o 4 Total Capacity: -73-0 gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: gallons Comments: �,�/ llgW T LG 2aa .S9 339,14 07 EHD Inspector: Reviewed Date: Entered Date: By Initial: By Initial: `Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of p oleum. "Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08