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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: E AORIAtV RAIVCA _ Page _L of Facility Address: City: 2 7 J :. Inspec ion te: �� d FA #: f�Z`�� PR #: Program le ent: 2,1?0 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. VTank(2820) El Containers (2821) #of Containers: TA#: 4!2b / Tc r / 1 Total Capacity: % ey d gallons Product Type: n�_p_) (per tank or cumulative for containers by product type) Install Date: E9 ank (2820) El Containers (2821) #of Containers: TA#: & `b ► `� Ig 2 Product Type: Lr p S Total Capacity:gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) Containers (2821) #of Containers: TA#: !9 ( q _D 3 - Pr ,�jy�"h Total Capacity: gallons Product Type. (per tank or cumulative for containers by product type) Install Date: ElTank (2820) E!� Containers (2821) #of Containers: TA#: `> v 4 r- Product Type: %//� ✓ �� 0% % Total Capacity: . ;S gallons —* (per tank or cumulative for containers by product type) Install Date: Tank (2820) El Containers (2821) #of Containers: TA#: 19 5` Product Type: gallons Total Capacity: > 64 g (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: Z o `� 0 gallons Total Capacity for Site: � gallons Comments: EHD Inspector: GBy Reviewed Date: Initial:Wo C'. - 001 Entered Date: By Initial: O *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. t `*Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08