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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTME 600 East Main Street, Stockton,CA 95202-3019 Telephone:(209)468-3420 Fax: (209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: / 6-I&I-10 S G N Page of Facility Address: City: Inspectiory�DD te: 3 9 3 6 ?'oN 5//// ,v FA#: PR#: Program Element: 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. er'Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: Total Capacity: / d O D O gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) 2 Containers (282 1) #of Containers: \ TA#: (>250 gallons) (>55 gallons and<250 gallons) 2 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: KK5nk (2820) Containers (2821) #of Containers: T #`. �5e iec.3 lU /( 50 gallons) (>55 gallons and<250 gallons) 3 _ Product Type: Total Capacity: S gallons (per tank or cumulative for containers by product type) Install Date: © Tank (2820) n- ontainers (282 1) #of Containers: I TA#: i '5 P c� (>250 gallons) (>55 gallons and<250 gallons) Q 4 Product Type: Total Capacity: 1515 gallons (per tank or cumulative for containers by product type) Install Date: © Tank (2820) lr Containers (2821) #of Containers: TA#: _ (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: a Capacity: 7 z C3 gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: I fo �� gallons Total Capac4ty for Site: j`d 3 S-/ gallons Comments: EHD Inspector: Reviewed Dat Entered Date: Cr J By Initial: V1j `til By Initial: 3 0 EHD 28-01 01/16/08