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SAN JOAQUIN COUNTY GOVIRONMENTAL HEALTH DEPARTMEN. 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 N e: FI�O R ✓�' 1,,v G Page of Facility Address: Cit Inspecti D e: 754'-00 AcIS 7f IV P FA#: PR#: Progra Elent: D 1tt33�� 0 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum >_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: TAA#: 7 q' (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: Total Capacity: 1000 gallons (yr tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TAM (>250 gallons) (>55 gallons and<250 gallons) /� 2 Product Type: �--��X� Total Capacity: 10 6 oy gallons (per k or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: aA 74-11PS 1 (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: Total Capacity: 2j lt,0 gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) Containers (2821) #of Containers: TA#: _ 10 (>250 gallons) (>55 gallons and<250 gallons) 4 / Product Type: Total Capacity: / 6 r gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>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: I j gallons Total Capacity for Site: `I 5 gallons Comments: EHD Inspector. Reviewed Date: Entered te:Da By Initial: o � � By Initial: EHD 28-01 01/16/08