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 L <br />Page /of <br />P7 199 R I T = /ICJ <br />Facility Address: City: <br />Inspectjopd�it r <br />li (J <br />2 ok- /=— sC-A Lo �✓ <br />FA #: <br />PR #: <br />Program Elem <br />0629337 <br />S <br />Tank/Container Information <br />Complete for all sites with cumulative aboveground storage of petroleum >_ 1320 gallons in tanks and containers over 55 gallons. <br />Complete one box for each tank or each cumulative container product type. <br />Tank (2820) ❑ Containers (2821) #of Containers: TAM <br />(>250 gallons) (>55 gallons and <250 gallons) <br />1 <br />Product Type: <br />Total Capacity: �ri3 e17 gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />5;d' ank (2820) ❑ Containers (2821) #of Containers: TA#: _ <br />Tj <br />2 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Product Type: <br />Total Capacity: 0 C') gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />L'�Tank (2820) ❑ Containers (2821) #of Containers: TAM <br />3 <br />(>250 gallons) (>55 gallons and <250 gallons) / <br />Product Type: /fE� <br />Total Capacity: ©d gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />❑ Tank (2820) /Containers (2821) #of Containers: TA#: <br />4 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Product Type: LI/,/,! a (y <br />-1, <br />Total Capacity: gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br />(>250 gallons) (>55 gallons and <250 gallons) <br />5 <br />Product Type: <br />Total Capacity: gallons <br />Install Date: <br />(per tank or cumulative for containers by product type) <br />Total Capacity this Page: j C. gallons <br />Total Capacity for Site: % 55 - gallons <br />Comments: <br />EHD Inspector: <br />Reviewed Date:Entered <br />By Initial: 1r /By <br />Date: <br />Initial: <br />Q 1 <br />EHD 28-01 <br />01/16/08 <br />