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r• <br /> SAN JOAQUIN COUNTY <br /> c:NVIRONMENTAL 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: <br /> CU � S LAY �tlM5 Yo ANG Page -of <br /> Facility Address: City: ionWP <br /> e L a GT r© NL�T� <br /> FA#: I � � PR� I Program <br /> Tank/Container Information Jz� <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks` and containers". <br /> Complete one box for each tank or each cumulative container product type. <br /> Kank (2820) El Containers (2821) #of Containers: TA#: �s;�J <br /> 1 Product Type: <br /> Total Capacity: U 0 0 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ank (2820) ❑ Containers (2821) #of Containers: TA#: 4,6/!2 <br /> 2 Product Type: <br /> Total Capacity: / (�'�� gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) ElContainers (2821) #of Containers: TA#: <br /> 3 Product Type: <br /> Total Capacity: r� gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Uk Tank (2820) El Containers (2821) #of Containers: STA "g') <br /> 4 Total Capacity: /i G1�' gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) 12 Containers (2821) #of Containers: Z TA#: <br /> 5 Product Type: &1,47-721L Z2L <br /> Total Capacity: .� gallons <br /> (per tank or cumulative for containers by product type) Install Date: /A <br /> Total Capacity this Page: 3 J r� gallons Total Capacity for Site: 'I `1 [Z gallons <br /> Comments: C <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> By Initial: m<' I Lf <br /> By Initial: <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 /> 09/12/08 <br />