BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ?NVIRONMENTAL HEALTH DEPARTMENT 000 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: S � Page of Facility Address: City: • Inspection D e: FA#: PR#: Progrgm Element: � 21 F0 06-,;N1 q I 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. Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: Total Capacity: / d O 6 gallons (per tank or cumulative for containers by product type) Install Date: Ql n (2820) ❑ Containers (2821) #of Containers: TA#: 951-7 &&90 (>250 gallons) (>55 gallons and<250 gallons) r 2 Product Type: Total Capacity: /P d 0 gallons (per tank or cumulative for containers by product type) Install Date: V4� nk(2820) ❑ Containers(2821) #of Containers: TAM 65-)`j (QD (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: Total Capacity: 1,600 gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (282 1) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (282 1) #of Containers: TAM (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 3 0 z9,0' gallons Ibtal Capacity for Site: gallons Comments: o EHD Inspector: t Reviewed Date: Entered Date: �g By Initial: vA 6By Initial: EHD 28-01 01/16/08