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SAN JOAQUIN COUNTY NVIRONMENTAL HEALTH DEPARTMEI ot)0 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/chd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: CID L U F - S Page of Facility Address: 00 3q00 w TdrJ City Inspect' n Date- ate•3 FA #:PR #: d Program Ele nt: -Z l ZC) � 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) ❑ Containers (2821) #of Containers: TA#: 06-17J,41 (>250 gallons) (>55 gallons and <250 gallons) Total Capacity: / 0 61 Product Type: 490 gallons Install Date: (per tank or cumulative for containers by product type) 'Sl_Tank (2820) V ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and <250 gallons) 2 Total Capacity: ) 0 0 Product Type: C --. a S6 1 i�j c gallons Install Date: P01 (per tank or cumulative for containers by product type) ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and <250 gallons) 3 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and <250 gallons) 4 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and <250 gallons) 5 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) Total Capacity this Page: / p O (� gallons Total Capacity for Site: /D .�(� a gallons Comments: 1 EHD Inspector: Reviewed By Initial: I Date- ` , �J G_ �`�, Entered Da By Initial: EHD 28-01 01/16/08