BILLING - Laserfiche WebLink

Home Browse Search

4? 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: M 11/ Page of Facility Address: City: Inspe ion Date: FA#: PR M Program El eme t: 15 3 52 0 5o -2- 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. 1/Tank (2820) ❑ Containers (2821) #of Containers: TA#: � �R 1Product Type: � DQo / Total Capacity: 00 gallons (per tank or cumulative for containers by product type) Install Date: Vank (2820) ❑ Containers (2821) #of Containers: TA#: 06-t95 3 2 Total Capacity: t"` gallons Product Type: (per tank or cumulative for coMainers by product type) Install Date: /Tank (2820) ❑ Containers (2821) #of Containers: ' TA L 3 Total Capacity: o D Q 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 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: gallons Comments: EHD Inspector: / Reviewed Date: Entered Date: By Initial: ,�q_o� By Initial: — +�� *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. �L **Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08