BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

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: r /A / 1/; N.J V/�/ � C�G� U Page - of Facility Address: City: Inspetio 132te: FA #: PR #: /'733 Program Element: zgjD 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. El Tank(2820) ❑ Containers (2821) #of Containers: TA#: z9�—L/ $ 1 A gallons Total Capacity: L� � g Product Type: �,- J ZZ (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: br-T.19s �o� 2 Total Capacity: U gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 � Product Type: Total Capacity: (;�"V gallons (per tank or cumulative for containers by product type) Install Date: #of Containers: TA//►#: Tank (2820) ❑ Containers (2821) 4 J C� Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: ad gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: z- S O gallons Total Capacity for Site: Z gallons Comment: EHD Inspector: /a �, [ Reviewed By Initial: Date: Entered By Initial: Date: "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