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Y 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: l <br /> G /lV G Page of <br /> Facility Address: ci : Inspecti Date: <br /> ,C12-�— Z 7 <br /> FA U PR#: V Pr ra men . <br /> D�o2� 04 2 jD <br /> Tank/Container Information <br /> Comnlete for all sites with cumulative aboveground storage of petroleum 21,320 allons in tanks'and containers". <br /> _ <br /> Complete one box for each tank or each cumulative finer roduct type. <br /> rT ank (2820) Containers (2821) <br /> #of Containe s: A#: X51 ri�LO <br /> 1 Product Type: <br /> notal Capacity: O gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ElTank (2820) U16ontainers (2821) #of Container : A#: 6'�� $ oZ�p o� <br /> 2 -� Product Type: T) <br /> Total Capacity: �� gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> El Tank (2820) Containers (2821) #of Containe S: TA#: BV )�07/0� <br /> 3 � � Product Type: <br /> Total Capacity: � gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> #of Containe s: A#: 191 ga[p`7 <br /> ❑ Tank (2820) &-c"Ontainers (2821) r-- <br /> 4 Product Type: <br /> Total Capacity: ISV gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 5 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: Z ZZ3 a gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHD Inspector: 77 � Reviewed Date: Entered Date: <br /> By Initial: By Initial: 5—h/'P <br /> "Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. <br /> "Container means a storage device designed to be moved when full. <br /> EHD 28-01 AST SURVEY FORM <br /> 09/19/08 <br />