BILLING - Laserfiche WebLink

Home Browse Search

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: 5 Page � of Facility Address: City: t> Inspect' D e: I oulMvo r, FA #: PR #: Program Element: n 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#:._Q,,5-IGA19% 1 Product Type: Total Capacity: / Cy � � gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TAp#: 2Product Total Capacity: 5'0m gallons Type: (per tank or cumulative for containers by product type) Install Date: #of Containers: TA#: ❑ Tank VContainers (2820) (2821) 3 / Product Type: Total Capacity: f 6 gallons (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: ` C gallons Total Capacity for Site: J611 71/' gallons Comments: EHD Inspector: Reviewed Date: By Initial:, Entered Date: By Initial 1l \) *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 09/12/08