BILLING - 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: ,� %'' C, /i/V J� j� 0 r Page 7 - of 7' Facility Address: _ City: % % �/ c�L % ��,�� Inspection D te: _ L. FA #:PR ICs M 699��? 7 Program Element: Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum ?1,320 gallons in tanks* and containers**. Com lee one box for each tank or each cumulative container product type. ❑ Tank (2820) /Containers (2821) #of Containers: TA#: 951 I? '-� 1Product Total Capacity: � %7'J gallons Type: ldt (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: y: gallons Product Type - (per (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 306 gallons Total Capacity for Site: gallons Comments: EHD Inspector Reviewed By Date: Initial: Entered By Initial:�5h,7/r?. 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 09/17/08