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4 � v 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 A 0 r Page L of 7/ Facility Address: City: r Inspection Date: o Z o v �' 0 FA#: PR#: U Program Element: 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. [D,"fank (2820) ❑ Containers (2821) #of Containers: TA#: Total Capacity: D 1 �� gallons Product Type: /"1 0 7-2 IL. L-1-(per tank or cumulative for containers by product type) Install Date: IJ/Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Total Capacity: Z- TO gallons Product Type: 'V /.G1, Ll 4!� (/'/ y (per tank or cumulative for containers by product type) Install Date: Z Tank (2820) ❑ Containers (2821) #of Containers: TA#: &tQ<3'v'5';5-7 t l� 3 Total Capacity: S-0 � gallons Product Type: _T�/� �� (per tank or cumulative for containers by product type) Install Date: ZTank (2820) ❑ Containers (2821) #of Containers: TA#: 06719a-L53 4 Product Type: 4"_f F �l Total Capacity: 3 0 P gallons (per tank or cumulative for containers by product type) Install Date: 9 4j:1 Q'Tank (2820) El Containers (2821) #of Containers: TA#: (' 5 r Product Type: O Total Capacity: > � gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page:/ r J (t> gallons Total Capacity for Site: d gallons Comments: EHD inspector: / 76y eviewed Date: ��p, Entered Date: Initial: It .� By Initial: *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