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SAN JOAQUIN COUNTY Nd fj L� ENVIRONMENTAL HEALTH DEPARTME _ 600 East Main Street,Stockton,CA 95202-3ui-y Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: a G T kz AJ tl ^ G 7 U Page � of Facility dress: City: Inspection Date: 6 - P10G T �L aL-l FA#: PR#: Pry ent: z S3 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum >1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. ❑-I ank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: ��,,t� Total Capacity: —'T'O y gallons (per tank or cumulative for containers by product type) Install Date: Yank (2820) ❑ Containers (2821) #of Containers: TA#: 6�5SI le 0,24 (>250 gallons) (>55 gallons and<250 gallons) 2 Product Type: 1 �� Total Capacity: d gallons (per tank or cumulative for containers by product type) Install Date: U Tank(2820) ❑ Containers (2821) #of Containers: TA#: 9�Q lP pp6— (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: C'Tank (2820) ❑ Containers (2821) #of Containers: TA#: d6-1& of)& (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: �"/4.T Total Capacity: fo gallons Install Date: (per tank or cumulative for containers by product type) Tank (2820) 12 Containers (2821) #of Containers: 0 TAM P(5-1lc�7 (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: D/ li Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 2 S 0 gallons Total Capacity for Site: gallons Comments: EHD Inspector: Reviewed Dat : Entered Date: C- By Initial: �3 b By Initial: g EHD 28-01 01/16/08