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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMEN, <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br />ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br />Facility Name: U <br />�r�VlL- <br />Page -4-' of <br />Facility Address: City: <br />3q 3,;� Altw-h �d Sfac�l <br />Inspection Date: <br />o�-ab� c <br />FA#: �� � � � �D _�Q/ � <br />PR #: � � �! 3 <br />t/U <br />Program Element: <br />ag o a <br />Tank/Container Information <br />Complete for all sites with cumulative aboveground storage of petroleum �t 1320 gallons in tanks and containers over 55 gallons. <br />Complete one box for each tank or each cumulative container product type. <br />❑ Tank (2820) eETContainers (2821) #of Containers: T <br />(>250 gallons) (>55 gallons and <250 gallons) <br />1 <br />Product Type. JAS#: <br />Total Capacity: gallons <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />