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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMEN- A0 East Main Street,Stockton,CA 95202-30' . Telephone:(209)468-3420 Fax:(209)468-3433 Web-- w� '�)gov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: 152R WA 9- Q I N C , Page�of Facility Address: ct I City: Inspen Date: S. V S TIIJ l�"%C A S l 0 FA VPR#: Program Element: 000 '21611 . S%5-9z� 25? 3 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum Z 1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. Er'Tank (2820) ❑ Containers (2821) #of Containers: -TA#: (>250 gallons) (>55 gallons and<250 gallons) 1 D � o o Product Type: Total Capacity: gallons (per tank or cumulative for c ntainers by product type) Install Date: EP"Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 2 -5 Product Type: Total Capacity: Z9' gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) Containers (2821) #of Containers: y TA#: (>250 gallons) (>55gallons nand<250 gallons) 'als 3 ��_�v Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: 0 Tank (2820) Containers (282 1) #of Containers: Z TA#: O'67&RA 1 (>250 gallons) (>55 gallons and<250 gallons) 4 0 0 Product Type: -2��A"'j a t Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) P,6ntainers (2821) #of Containers: 'v TAM (>250 gallons) (>55 gallons and<250 gallons) 6 5 44Q Product Type: 7 Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: ��f� gallons Comments: i r o�'L t u tY+✓ EHD Inspector: Reviewed Date: Entered Date: By Initial: �� ,� '0 By Initial: EHD 28-01 In 01/16/08