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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209)468-3433 Web:www.sjgov. /ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FO C <br /> Facility Name: <br /> LLC Page of <br /> Facility Address: City- Inspection Date: <br /> cop 1-�Ac&4A '?S23� 7-Z 1 -a-ze-610 <br /> FA#: R M Program Element: <br /> 0014, 306- e q CQ T <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks"and containers". <br /> Complete one box for each tank or each cumulative container product type. <br /> g Tmnk 2820` F-1 Containo," rtor t TA#: D�� A a 5 <br /> 1 Total Capacity: g OO &,Cj1 _Product Type: %PSA <br /> (per tank or cumulati,• ,ntaineC§by ptoduct tyac, <br /> 1 Tank (2820ontainers (282 ) <br /> Total <br /> ��. Prod t Type: <br /> apace y: a o <br /> (per tank or cumulativefor container by product type) I <br /> Tank (2b,-,., [j Containers (2821) <br /> * TA#: _ a <br /> 3 Total Capacity: .n� �?std jQns r-roduct Type: /�� �^ -C� ,z <br /> (per tank or cumulative for y prod_uct type) 112 j'-C—`/� L <br /> #of Contained: <br /> ' <br /> Tank (2820) ❑ <br /> Co tait�ers21) <br /> .V- Total Capacity: 60tt® oduct Type: <br /> (per tank or cumulative for contain .sr-by roduct type) I nstall Date: D <br /> ❑ Tank (2820) .Containers (2821) #of Containers: -VS TA#:Q 2 <br /> 5 Total Capacity: 2.TO Product Type: rC % <br /> gallons <br /> (per tank or cumulative for containers by product type) Install Date: ©� <br /> Total Capacity this Page: gallons Total Capacity for Site: allons <br /> Comments: ed r - - 6,6u � <br /> d iI t <br /> Z, 1 h 0 <br /> �. <br /> ` <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> U�P By Initial: ^� fpo By Initial: '7 g D <br /> "Aboveground storage tank m ans tank that has the capacity to store 55 gallons or more oT petroleum. <br /> "Container means a storage dg/be designed to be moved when full. <br /> EHD 28-01 AST SURVEY FORM <br /> 09/12108 <br />