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SAN JOAQUIN COUNTY tNVIRONMENTAL 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: Is S f A] a ti' Page of Facility ' ' ' 77 City: Inspecti i Dat FA #: PR M % tL2 2' g ProgrIft E e ent: *z C 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) 1:1 Containers (2821) #of Containers: TA#: g 1 0Product Total Capacity: � � � gallons Type: r-'/1 s F- 2 (per tank or cumulative for containers by product type) Install Date: Z ank (2820) ❑ Containers (2821) #of Containers: TA#: 06-1 2 Total Capacity: (-�� gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ElTank (2820) ©"Containers (2821) #of Containers: TA#: 3 Type: XI'l o To I/<- &f Total Capacity: -�- gallons (per tank or cumulative for containers by product type) Install Date: ` ❑ Tank (2820) 12 Containers (2821) #of Containers: TA#: ' �A A L � Ll 4./ Total Capacity: �� gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) 2 Containers (2821) #of Containers: TA#: ©LSl q1 S%,R 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Pa gallons Total Capacity for Site: / r gallons Comments: 1 (/IS o — 1" 31" To 1,1)1,6114,, � EHD Inspector: Reviewed Date: By Initial: 16•'-P-01 Entered Date: By Initial: �J *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