Laserfiche WebLink
SAN JOI.QUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTM <br />600 East Main Street, Stockton, CA 95202-30,-7 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Weh: www.sigov.org/ehd <br />ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br />Facility Name: <br />#ST�-'C� �z rf� ��21G GC �Q,! 1 f�if <br />Page r��C�ii%Q of <br />Facility Address: <br />33�� <br />s • HU -y ?9 <br />City:�� <br />lG <br />Inspecti <br />31�,z <br />FA #: <br />0 0 0(/67 <br />PR #: <br />�z 62o <br />Program Element - <br />lement:Doo <br />Z� l <br />Tank/Container Information <br />Complete for all sites with <br />cumulative aboveground storage of petroleum z 1320 gallons in tanks and containers over 55 gallons. <br />Complete one box for each tank or each cumulative container product type. <br />ER"'Tank (2820) <br />❑ Containers (2821) <br />#of Containers: TA#: <br />/ e(,Q6,; <br />1 <br />(>250 gallons) <br />(>55 gallons and <250 gallons) <br />Product Type: �r—iI <br />Total Capacity: <br />r o ° gallons <br />Install Date: <br />(per tank or cumulative for containers by product type) <br />9'-`Tank(2820) <br />❑ Containers (2821) <br />#of Containers: TA#: <br />2 <br />(>250 gallons) <br />(>55 gallons and <250 gallons) <br />Total Capacity: <br />.S o o gallons <br />Product Type: <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />ank (2820) <br />b ontainers (2821) <br />#of Containers: <br />3 <br />(>250 gallons) >5 gallons and Q50 gallons) <br />ro uct Type: ?d2 UJ <br />_ <br />Total Capacit : <br />gallons <br />Install Date: <br />or cumulative for containers by product type) <br />❑ Tank (2820) <br />G7, -Containers (2821) <br />#of Containers: TA# - <br />4c <br />(>250 gallons) <br />(>55 gallons and <250 gallons) <br />a 129 <br />ype: <br />Total Capacity. <br />gallons <br />Install Date: <br />r cumulative for containers by product type) <br />� <br />l <br />El Tank (2820) <br />(>250 gallons) <br />Containers (2821) <br />(>55 gallons and <250 gallons) <br />#of Containers: — -'fA# <br />5 <br />_ __ - - <br />Product Type: <br />U r <br />Total Cavity; --, <br />j13 gallons <br />or cumulative for containers by product type) <br />Install Date: <br />Total Capacity this Page: <br />I DOC <br />gallons <br />Total Capacity for Site: <br />;2�--�O gallons <br />Comments: <br />�7 <br />14Z7C11,11Lf, <br />u 3 2 <br />g'l <br />EHD Inspector: <br />Reviewed Date: <br />y Initial: <br />Entered <br />By Initial <br />Date. <br />'? L� g <br />EHD 28-01 <br />01/16/08 <br />