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r SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTME 600 East Main Street, Stockton,CA 95202-3k- Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: p�- r✓L ,� Page -�" of J Facility Address: City: Inspection Daw FA#: PR#: Program 1 ment: Tank/Container Information Complete for all sites with cumul ive aboveground storage of petroleum �1320 gallons in tanks and containers over 55 gallons. Co ete one ox for each tank ach cumulative container product type. ❑ Tank (28 0) ntai r 2821) #of ontai A (>250 gallons) ga Ions <25 allons) 1 Prod e: o f1�7\ A Total Capaci g 1 (per tank or cumulativ r containers by product type) Install Date: �! Tank (2820) [ontainers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) --rz� 2 Product Type: O 'S �� Total Capacity: '2—.TO gallons (per tank or cumulative for containers by product type) Install Date: Er Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 3 � Product Type: ��P Total Capacity: ICO C gallons Install Date: (per tank or cumulative for containers by product type) El Tank (2820) ❑ Containers (2821) #of Containers: TA#: 105x20 $� (>250 gallons) (>55 gallons and<250 gallons) '^ 4 Product Type: �/ � �/J/��C�C� Total Capacity: l C, --1 gallons (per tank or cumulative for containers by product type) Install Date: l P� Tank (2820) ❑ Containers (2821) #of Containers: TA#: g (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: Z--,;� --3Co gallons Comments: 1106- a 6- Q r add1-7 ' - EHD Inspector: Reviewed t�L Date:LA Entered ate: By Initial: �(/`_ By Initial: EHD 28-01 01/16/08