Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTP <br /> 600 East Main Street, Stockton,CA 95202--)029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: •, <br /> L© D 1 A l l2 O n 7 Page—/—of _ <br /> Facility Address: City: ` Ins a ion D <br /> Vin70e: <br /> iu 14v� �a <br /> FA#: pit#: Program El ent: <br /> 00 112/ O SZ Sf �8 <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum >_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) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: <br /> Total Capacity: 0 o a gallons <br /> (per or cumulative for containers by product type) Install Date: <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA# (p-71 W <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: <br /> Total Capacity: /O o 0 40 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: It gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity-this Page: 7-0 0 0 0 gallons Total Capacity for Site: Z O D D gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> / By Initial: b�,y.p By Initial: Z Ole <br /> EHD 28-01 <br /> 01/16/08 <br />