Laserfiche WebLink
t <br /> a <br /> 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,sigov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> k• a C kr i g(cr c..- <br /> -1 - I Page of <br /> Facility Address: ///� 1 /' L / City: ) Inspection Date: <br /> 2� /"� \nT�o C�1 v't��L (� -7110�O <br /> FA#: PR#: ProgramElement: <br /> l�h� oSZSS 2/- 2� t <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 /> ❑ Tank (2820) Containers (2821) #of Containers: Z TA#: o S l(,S6 6 1 <br /> 1Product Type: <br /> o, / <br /> Total Capacity: //C) gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> A Tank (2820) ❑ Containers (2821) #of Containers: TA#: o S! 6 FSS 2- <br /> 2 Product Type: Sf, - 3 0 iA-o74, aiJ <br /> Total Capacity: �'7 Z- gallons <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> A�T Tank (2820) ❑ Containers (2821) #of Containers: TA#: o S /6 S'6 3 <br /> 3 Product Type: w4-Y � o, <br /> Total Capacity: � � gallons <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> * Tank (2820) ❑ Containers (2821) #of Containers: TA#: aS/6 ':j(6L- <br /> 4 Total Capacity: -5?—G gallons Product Type: 7-r7' <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 5Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> Total Capacity this Page: 1 33 Lt gallons Total Capacity for Site: j Lj gallons <br /> Comments: <br /> EHD In <br /> specto ; Reviewed Date: Entered Date: <br /> By Initial: h� � \-\A.tBy Initial: <br /> ,41310'v') ground 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 <br /> 09/12/08 AST SURVEY FORM <br />