Laserfiche WebLink
SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <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 />l-b,I <br />.�nn/l\ { h / 1 /i �� `ii l Vl nl , , �i 1 . Lr i�"-� panP_ t - ' of / _ <br />- - -� -- - ---•-•a- ---.— ...— v —1— aion cias o ait,apclully w atvie co gallons or more of petroleum. <br />**Container means a storage device designed to be moved when full. <br />EHD 28-01 <br />09/12/08 AST SURVEY FORM <br />- '-' vb- <br />Facility Address: <br />Y V`C'\1 <br />City: <br />�� <br />Inspection Date: <br />FA M PR #: <br />Cab <br />C`\ 1 i U-3 )-q <br />Program Element: <br />-2X �Z <br />Tank/Container <br />Information <br />Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons <br />in tanks* and containers". <br />Complete one box for each tank or each cumulative container product <br />type. <br />❑ Tank (2820) ,OContainers (2821) <br />#of Containers: �_ TA#: <br />1 <br />Total Capacity: I ' gallons <br />Product Type: � <br />��� L <br />(per tank or cumulative for conta ners by product type) <br />Install Date: <br /> .� <br />P' Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: <br />2 <br />Total Capacity: gallons <br />Product Type: �� tri. Q�,tp�e <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />, <br />❑ Tank (2820) /0 Containers (2821) <br />#of Containers: �_ TA#: <br />3 <br />Total Capacity: G> 5 gallons <br />Product Type: / <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />� � <br />❑ Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: <br />4 <br />Total Capacity: gallons <br />Product Type: <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />❑ Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: <br />5 <br />Total Capacity: gallons <br />Product Type: <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />Total Capacity this Page: gallons <br />Total Capacity for Site: <br />gallons <br />Comments: <br />EHD Inspector: <br />Reviewed <br />Date: <br />Entered <br />Date: <br />By Initial: <br />By Initial: <br />- - -� -- - ---•-•a- ---.— ...— v —1— aion cias o ait,apclully w atvie co gallons or more of petroleum. <br />**Container means a storage device designed to be moved when full. <br />EHD 28-01 <br />09/12/08 AST SURVEY FORM <br />