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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:'A1 �—jwI rYnit� V v� 1�-- �`S Page ez of Facility Address: City: Inspec on FA M PR M Program Element: 1? 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. Tank (2820) ❑ Containers (2821) #of Containers: TA#: Q6-� 1 pzj Total Capacity: gallons Product Type: C�� Q-0AO ,�---, (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: I TA#: 2 0Product Total Capacity: 6 gallons Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Total Capacity: 'Lt--trJ gallons Product Type: C�1 (per tank or cumulative for containers by product type) 1 Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: I TA#: 4 �.�..,�r� Total Capacity: 4L fJ u �./ gallons �1 Product Type: UIS. (per tank or cumulative for containers byproduct type) Install Date: ❑ Tank (2820) ❑ Containers (2821) TA#: S5:1q #of Containers:.', 5 Total Capacity: M gallons "_ Product Type: 81e0- (per ta�k r cumulat ve f r nt by prodyct type) tlr✓ S Install Date: Total Capacity this Page: ( gallons I Total Capacity for Site: �j� 3G -,lions Comments: EHD Inspector: /\ /4�s Reviewed Date: Entered Date: L I By Initial: By Initial: 1 *Ak., .,A ..F,..--- 4._.-1_ .Y �—!Vu"u OLUIQyC L4211R 111Cd115 a tahK that nas the capacity to store 55 gallons or more of petroleum. **Container means a storage device designed to be moved when full, EHD 28-01 09/12/08 AST SURVEY FORM