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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMEN, 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Weh: www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM F ilityl Name: I, a1 �1� - 3c, SSI A �` �tiN�e- �`.��1 U►v Page of Facility Address: City: Inspection Date: FA #:PR #: O 6=1 Program lement: b 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. 1A Tank (2820) ❑ Containers (2821) #of Containers: TA#: � ? / (>250 gallons) (>55 gallons and <250 gallons) 1 Total Capacity: 6 , � gallons Product Type: (per tank or cumulative for containers by product type) Install Date: EHD 28-01 01/16/08 X Tank (2820) ❑ Containers (282 1) #of Containers: l TA#: 2 (>250 gallons) (>55 gallons and <250 gallons) R Product Type: C'a"��Yl rve., Total Capacity: C gallons (per tank or cumulative for con finers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: �9u�aD9 3 (>250 gallons) (>55 gallons and <250 gallons) Product Type: Total Capacity: / OQD gallons -(P (per tank or cumulative for contau.— -, product type) Install Date: ❑ Tank (2820)Containers (2821) #of Containers: �� TA#: 1i5gDQ ,?7 4 (>250 gallons) (>55 gallons and <250 gallons) � Total Capacity: %� op P5 Product Type: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) gContainers (282 1) #of Containers. TA#: 5 (>250 gallons) (>55 gallons and <250 gallons) Product Type: 6 � O/ / 5� Total Capacity: 1 1 D gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: ILI r-'� gallons Total Capacity for Site: I gallons Comments: Sto 6-c� n ��d c-2 ray EHD Inspector: Reviewed By Initial: Date: �} " .r \ , 1 Entered Date: By Initial: i EHD 28-01 01/16/08