BILLING - Laserfiche WebLink

Metadata

Thumbnails

Annotations

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: 6-- A// /)-//I �—/ Page Si of Facility Address: ¢ SOb r , /�� City: Inspection D2f%j p�} 'H/ tel/ ( I FA#: / PR#: Program Element: b.t a 2 71 2 S3 0 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#: 19S/ g 0'27 8 m 1Product Type: / f��0t-z- Q/ Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: E5/Tank (2820) ❑ Containers (2821) #of Containers: TA#: �'1 go27 2 0Product Type: _�/ O Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: L� Tank (2820) El Containers (2821) #of Containers: TA#: �h f go2�� 3 Total Capacity: 7,2X) gallons Product Type: (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: lo -1 gallons Total Capacity for Site: gallons Comments: EHD Inspector: n Reviewed Date: Entered Date: tJ� By Initial: By Initial: / `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 0911 2108