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: J�qi C) (1,�a i= s Page —j --,of Facility Address: / "'� A/ -%S/ City: Inspec 'o Date: 1GbC'�� FA it: PR M Progra lem t: g Tank/Container Inform Complete for all sites with cumulative aboveground storage of pet leum 2!1,,-320 gallons in tanks* and containers". Complete one box for each tank or each cumAilative, iiner product type. ❑ /ank �' �'ontainers #of Contain rs: TA#: (2820) (2821) _ /4r 1 Total Capacity: gallons Product Typ —��-'----� (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Total Capacity: gallons Product Type: (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 Total Capacity: 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: EHD Inspector: Date: Entered Date: TRevievved y Initial: By Initial: '� �v ;T? "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 ogwwns