Laserfiche WebLink
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.sjgov.org/ehd <br />ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br />Facility Name:J <br />Pag _ of_ <br />Facility dre s City: <br />I� <br />Inspection Da <br />1�, y.� <br />FA #: 1 <br />PR #: <br />Program Elernwt—N <br />Tank/Container Information <br />Complete for all sites with cumulative aboveground storage of petroleum ?1,320 gallons in tanks` and containers". <br />Complete one box for each tank or each cumulative container product type. <br />#of Containers: TA#: 75'?5 <br />❑ Tank (2820) Containers (2821) <br />� II — <br />1 <br />Product Type: <br />Total Capacity: �D� gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />El Tank (2820) ontainers (2821) #of Containers: O5 ( -7 `2(42 <br />2 <br />cI,� STA#: <br />Product Type: <br />Total Capacity: gallons <br />0 <br />(per tank or cumul ve for containers by product type) Install Date: <br />#of Containers: �_ TA#: 295-1 -757'?7 <br />❑ Tank (2820)L Containers (2821) <br />3 <br />Product Type: P <br />Total Capacity: 59gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />❑ Tank (2820) Contn�ers (2821) #of Containers: TA#: ^l 5q <br />4Product <br />Type: <br />Total Capacity: J gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />❑aT(2820) ❑ Conta• rs (2821) #of Containers: TA#: <br />5Tocit <br />ons Prod �e: - = <br />(per tank or cumulative for containers by product type) Install Date: <br />Total Capacity this Page: gallons <br />Total Capacity for Site: Z Jd gallons <br />Comments: <br />T G L-A C7 <br />EH Ins ect r: <br />aaa—," <br />Reviewed Date: <br />By Initial: <br />Entered Date: <br />By Initial: <br />dill-, <br />rA66veg?6und storage tank m ns a tank that has the capacity to store 55 gallons or more of petroleum. <br />"*Container means a storageldevice designed to be moved when full. <br />EHD 28-01 AST SURVEY FORM <br />09/12/08 <br />