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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 oveground 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 09/12/08 AST SURVEY FORM Facility Name: Pale � of Facility Address: ` ^ city. InspgctionCDat1e:: FA #: PR #: Program Element: 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. [ Tank (2820) ❑ Containers (2821) #of Containers: TA#: B 1 Total Capacity: gallons q Product Type: (. a (per tank or cumulative for c tainers by product type) Install Date: El (2820) ontainers (2821) #of Containers: TA#:1�y / 2 Total Capacity: gallons 2 Product Type: �A Q, (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) N Containers (2821) #of Containers: `T TA#: gq j 3, r; Total Capacity: � gallons Product Type: ESI (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) &Containers (2821) #of Containers: 1A#: 4_t Total Capacity: SS- gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Tank (2820) El Containers (2821) #of Containers: TA#: 5 Total Capacity: �J p Y� gallons Product Type: t tr (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: 9 _ gallons Comments: EHD Inspector: Reviewed By Initial: Date: l'�, lt7 Entered By Initial: Date: "Ab �� oveground 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 09/12/08 AST SURVEY FORM