BILLING - Laserfiche WebLink

Home Browse Search

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: 4 DSSl/ter �_4 11/1 - Page of Facility Address: r ty; Inspection Dater FA#: / - PR M Program Element: Z 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. D'Tank (2820) El Containers (2821) #of Containers: TA#: _ D� y gallons Product Type: / 1 Total Capacity: /� 0" O (per tank or cumulative for containers by product type) Install Date: El Tank (2820) Containers (2821) #of Containers: TA#: 2 Product Type: Total Capacity: 6 0 gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) r Containers (2821) #of Containers: �_ TA#: D `J l 212-7 3 '' Product Type: Iz'Of-d/'L 0"6 Total Capacity: S�( gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 4 Total Capacity: 'Z O-" gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 1 (� gallons Total Capacity for Site: gallons Comments: V- G► EHD Inspector: Reviewed Date: Entered Date.*,,, By Initial: By Initial: c *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