BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTNi 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: ,,/ -} --- -�--� eiOJJT� �[-� / Page of Facility Address: City: ��G% Inspection Date: 10// -? z 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. ❑ Tank (2820) Pr Containers (2821) Containers. TA#: �j l.,( 1, Q 1Product (>250 gallons) (>55 gallons an <250 -galla s 9— D Type: Total Capaci y: gallons --tank or cumulative for containers by product type) Install Date: FZ/Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 (>250 gallons) (>55 gallons and <250 gallons) 5 32 Product Type: /� 0/0C (� / Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) M Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 (>250 gallons) (>55 gallons and <250 gallons) 1 —Il�dua-Type: r Total Capacity:) ga tons Install Date: Cumulative for containers by product type) L� ank (2820) ❑ Containers (2821) #of Containers: TA#: P, a B 1 y 4 (> 50 gallons) (>55 gallons and <250 gallons) t-� I � C'/ Product Type: _�,��G� O/ To Capacity: al gallons Install Date: (p tank or cumulative for containers by product type) C Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 (>250 gallons) (>55 gallons and X250 gallons) Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) Total Capacity this Page: �� gallons Total Capacity for Site: gallons Comments: f3 3 XA �- fjtw 42tZ) V7 66-d f r, J �l EHD Inspector: _ Reviewed Date: I By Initial: `t, `` 3 1231 `� Entered Dat • x By Initiale-P z �ld EHD 28-01 �f U 113 Ru 01/16/08 l