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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 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: � C a d C i(LI U Page / of Facility Addre : City: Inspectin D te: 0 FA#: / PR M Program Element: Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks`and containers". Complete one box for each tank or each cumulative container product type. VTank (2820) ❑ Containers (2821) #of Containers: TA#: 196-/ 7`d"/aj;o 1 Product Type: L�' Total Capacity: /000 gallons S 97 (per tank or cumulative for containers by product type) Install Date: U2/Tank (2820) ElContainers (2821) #of Containers: TA#: 2 r- Product Type: Total Capacity: 0 0 gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) /- Containers (2821) #of Containers: / TA#: 3Product Type: 1110Taf2 o r (/ Total Capacity: s;� gallons (per tank or cumulative for containers by product type) Install Date: ElTank (2820) Containers (2821) #of Containers: TA#: I�`) 1 4Product Type: J4Y�2 U U 0(b Total Capacity: § S gallons (per tank or cumulative for containers by product type) Install Date: El Tank (2820) ❑/containers (2821) #of Containers: Y TA#: ��/*7 R7-22 5 Product Type: /il/A S��" (� t f t 2 Total Capacity: /'/ � gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 122.,19 gallons Total Capacity for Site: gallons Comments: EHD Inspector: Reviewed Date: Entered Date: • By Initial: vt IA 0 By Initial: k a �e 'Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. "Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08