Laserfiche WebLink
SAN JOAQUIN COUNTY <br />?NVIRONMENTAL HEALTH DEPARTMENT <br />44 . J0 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 />T o Toy✓ D 0D <br />Page of <br />Facility Address: <br />3 3 A L,'70 CZN" <br />City: <br />/2 % <br />Insr—ti .,. n9t,.. <br />d A✓ i 7- 3 /- o <br />FA #: PR #: <br />6 C>O 4'76 <br />D <br />Program F -ent: <br />'2 19 31 <br />Tank/Container Information <br />Complete for all sites with cumulative aboveground storage of petroleum >_ 1320 gallons in tanks and containers over 55 gallons. <br />Complete one box for each tank or each cumulative container product type. <br />Ly Tank (2820) ❑ Containers (2821) <br />#of Containers: <br />TA#: 19± j�� `7 <br />1 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />ti <br />Product Type: O l <br />,/ <br />Total Capacity: 2 gallons <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />lel ank (2820) ❑ Containers (2821) <br />#of Containers: <br />TA#: <br />2 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />" <br />Product Type: //j�.r'� <br />Total Capacity: L? I gallons <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />Tank (2820) ❑ Containers (2821) <br />#of Containers: <br />TA#: 0,.f5_N6�� <br />3 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Product Type: ©/ <br />Total Capacity: 7i7 -�( gallons <br />Install Date: <br />(per tank or cumulative for containers by product type) <br />❑ Tank (2820) 19i ontainers (2821) <br />#of Containers: TA#: <br />4 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />_� <br />Product Type: 4 <br />�c <br />Total Capacity: gallons <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />Tank (2820) ❑ Containers (2821) <br />#of Containers: <br />TA#: <br />5 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Product Type: A.S� <br />, <br />Total Capacity: / 0 0 Q gallons <br />Install Date: <br />(per tank or cumulative for containers by product type) <br />Total Capacity this Page gallons <br />Total Capacity for Site: Alons <br />Comments: <br />EHD Inspector: <br />Reviewed <br />By Initial: <br />1 Date:Entered <br />, �J <br />Date: <br />By Initial: <br />EHD 28-01 <br />01/16/08 <br />