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: rA Page of Facility Address: /f'% City: S l YN �� i PAI Inspecti n Da L� V FA #: 13 PR #: 3 Ct I ProgVaifi Element: 2� 30 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum al,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#: 1Product Type: y 0 "A Total Capacity: O gallons � (per tank or cumulative for containers by product type) Install Date: #of Containers: TA#: 4i�--Z 213,(12 ❑ Tank I Containers (2820) (2821) 2 Z Product Type: /'I-/-�� %�2ir Cl � Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: #of Containers: / ZTA#: ❑ Tank (2820) &6ontainers (2821) 3 Product Type: Total Capacity: 6(o gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Total Capacity: / 0 4 0 " gallons Product Type: �r�fai (per tank or cumulative for contAiners by product type) Install Date: Tank (2820) El Containers (2821) #of Containers: TA#: 5 Product Type: Total Capacity: gallons (per tank or cumulative for cont Hers by product type) Install Date: Total Capacity this Page: 2 (� gallons Total Capacity for Site: �� () 60 gallons Comments: "q Z4 D 0 3 ry 17 EHD Inspector: Reviewed Date:�p By Initial: ` �, Ol. L� Entered Date: By Initial: q1 I *Aboveground storage tank means a tank that has the capacity to store 55 gdllons or more of pbtroleum. I **Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08