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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: Z S N C-- Page of Facility Address: If City: r 5 1-0 Inspection Dat . o s. C j-�/ FA #: PR #: I 12 ement: 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#: 1 Product Type: Total Capacity: % �'�% gallons (per tank or cumulative for containers by product type) Install Date: ank (2820) ❑ Containers (2821) #of Containers: TA#` oZ� 2 Product Type: ,�%(Y2/- Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ank (2820) ❑ Containers (2821) #of Containers: TA#: 19 i r a. -7 3 Product Type: Total Capacity: % gallons (per tank or cumulative for containers K product type) Install Date: #of Containers: TA#::. (gam?� El Tank (2820) I -Containers A, G (2821) 1 Z %J �- �LI OIL 4 Product Type: / Total Capacity: .� gallons (per tank or cumulative for containers by product type) Install Date: ElTank (2820) L?C' ontainers (2821) #of Containers: TA#: Product 5 �- Type: Total Capacity: f gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 3//0 gallons Total Capacity for Site: 3 z 0 gallons Comments: rjGLVX CAM eoL EHD Inspector: 7eviewed Date: Initial: oo %r� Entered Date: By Initial: 'a/ZA *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