Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <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 /> C i 0 V p A//Vo IV 1 /0 1tj N AjotV i /"q� j S Page _Z_ of <br /> Facility Address: f City: Inspec ion Date: <br /> r7S �3v ivs C oF� © G K o �4� 9z3/o� <br /> FA#: PR#: Program Element: <br /> CL r,6-c3z�?5? 7!2 -�Z-F� a <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks*and containers". <br /> Complete one box for each tank or each cumulative container product type. <br /> ank (2820) Containers (2821) #of Containers: TA#: doh <br /> 1 Product Type: 44 G%C1� 0 r <br /> Total Capacity: 5 S gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> VTank (2820) ElContainers (2821) #of Containers: TA#' <br /> 22 r^ gallons Product Type: <br /> Total Capacity: <br /> (per tank or cumulative for colfitainers by product type) Install Date: <br /> Lil Tank (2820) ElContainers (2821) #of Containers: TA#: <br /> 3 �r Product Type: S <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2$20) ❑ Containers (2821) #of Containers: .. TAS <br /> #: f�u`l �cDa <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 /> 5 Total Capacity: _gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: �(�J gallons Total Capacity for Situ 3 (j d gallons <br /> Comments: <br /> [0Ll <br /> a CAI <br /> 2.S'0 <br /> J <br /> EHD Inspector: / Reviewed Date: Entered Date: <br /> By Initial: By Initial: q J,,*,-q,f& <br /> "Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. <br /> *"Container means a storage device designed to be moved when full. <br /> EHD 28-01 AST SURVEY FORM <br /> 09/12/08 <br />