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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-31029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: -'k/P L'-' Page Facilit Address:I _ ( 1 � Puu City: Inspection ate- F #: PR #: Program Element: p5AV13cr 2- Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks` and containers`*. Complete one box for each tank or each cumulative container product type. n Tank (2820) ❑ Containers (2821) #of Containers: TA#: 05/ 1 Total Capacity: gallons Product Type: j2�� (per tank or cumulative for containers by product type) Install Date: ulr4L— Tank (2820) ❑ Containers (2821) #of Containers: TA#: S51 2Product 9plobTotal Type: 0 i` Capacity: gallons (per tank or cumulative for cont iners by product type) Install Date: 3 [Tank (2820) ❑ Containers (2821) #of Containers: TA#: Product Type: L Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) [containers (2821) #of Containers: TA#: Z914i-/ 7,513 4 75'-) Product Type: Total Capacity: gallons (per tank or cumulative for ontainers by product type) Install Date: 5 ❑ Tank (2820) Containers (2821) --y .y Total Capacity: ga Ions #of Containers T� TIA#: Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: ' p �(� �Ions Total Capacity for Site: 2—gallons Comments: a EHD s ecto : Reviewed By Initial: Date: \ O l�-Z'p- 0 Entered Date: By Initial: �g dAboveground storage tank moAs a tank that has the capacity to store 55 gallons or more of petroleum. t `*Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08