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t ` 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: _ U/c 5 T C N DAIAy 2, Page -4�:of Facility Address: City: Inspection ate: 763 ti � c�� TT d T2s' FA#: PR M Progra Elem nt: a 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. EB"Tank (2820) ❑ Containers (2821) #of Containers: TA#: 06-1 1 Product Type: �� 1`� �%LJ Total Capacity: � gallons -�� (per tank or cumulative for containers by product type) Install Date: rank (2820) ❑ Containers (2821) #of Containers- TA#: ��'/,� 2 Total Capacity: 'Z,C� 5--/ gallons Product Type: �/'�' J f"d/�/ d/ (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Total Capacity: �� gallons Product Type: ��%C� p (per tank or cumulative for containers by product type) Install Date: Gunk (2820) ❑ Containers (2821) #of Containers: TA#: 24 3 4 Product Type: /'jf4.� Z 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: 930 gallons Comments: D I Ali 1-0 �11 � r S3 EHD Inspector: Reviewed Date: Entered Date:_ By Initial: �'1 By Initial: qr g !�/-,,? *Aboveground storage tank means a tank that has the capacity to store 55 gall ns or more of petroleum. D **Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08