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: 4 T — L( Page of Facility Address: City: Inspe tion D W: FA#: PR#: _ Program Element: Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum ?1,320 gallons in tanks*and containers'". Complete one box for each tank or each cumulative container product type. ElTank (2820) VContainers (2821) #of Containers: TA#: ✓ ��/ (� 7 '_. 1 Total Capacity: �r ,j gallons Product Type: l4� /l 0 / (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: S gallons Total Capacity for Site: gallons Comments: EHD Inspector: h / Reviewed Date: Entered Date: J By Initial: By Initial: <? "Ale *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 09/17inR/nR