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r f SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 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 Name: L 0 G 0 KC, PD 5 Page of Facility Address: City: Inspection Date: r� FA#: PR Program Element: / 7 8S 6 - 2_ �?n Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum >tl,320 gallons in tanks* and containers**. Complete one box for each tank or each cumulative container product type. 1 0/Vq/ C�'Tank (2820) 0- Containers (2821) #of Containers: TA#: _66 1 Product Type: Total Capacity: ( � �� gallons (per tank or cumulative for containers by product type) Install Date: �' El(2820) Containers (2821) #of Containers: TA#: C 2 s` �� Product Type: Total Capacity: .� gallons (per tank or cumulative for containers by product type) Install Date: 1794ank (2820) ❑ Containers (2821) #of Containers: TA#: D 3 =— Product Type: Total Capacity: J jgallons (per tank or cumulative for containers by product type) Install Date: L4/Tank (2820) El Containers (2821) #of Containers: TA#: �`� I �'� r),— p � 4 r' C," h Product Type: 1;q Total Capacity: .7 � gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) Q Containers (2821) #of Containers: TA#: 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Pag gallonsTotal Capacity for S �0 — gallons Comments: EHD Inspector: Reviewed _I Date: Entered Date c By Initial: Utj By Initial: D *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. **Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08