BILLING_PRE 2019 - 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: r/��%�,�1�/ ��' /�L� NNC�r✓� �.,r'f�'/�iSPage — of Facility Address: ` City: Inspe ion_D e: _ FA#: PR#: Program Element- 0,63 0 lement0,630 z Y 3�� 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. M-/Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Product Type: ! J 'r Total Capacity: � r gallons (per tank or cumulative for containers by product type) � Install Date: /♦�/ n Tank (2820) ❑ Containers (2821) #of Containers: TA#: J I 2 Product Type: Total Capacity: �`"�,'�j gallons (per tank or cumulative for containers by product type) Install Date: %�L/� %'11r �—'A 1 J Tank (2820) ❑ Containers (2821) #of Containers: TA��#: 3 Total Capacity: `^' -� Product Type: p y: � gallons (per tank or cumulative for containers by product type) ^~^ s Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: Product Type: p y: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: �� gallons Total Capacity for Site: gallons Comments: EHD Inspector: Reviewed Date: Entered Date: 71 By Initial: By Initial: *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