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• 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: swt )5 N D Page --L of Facility Address: City:5v inspection Date® 00 V�✓� CL / Tool C, o� T / o FA#: PR#: Program Element: db��o 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. ank (2820) ❑ Containers (2821) #of Containers: TA#: 1Product Type: ��.�i-' Total Capacity: 2 �9-?� gallons (per tank or cumulative for containers by product type) Install Date: LR'Tank (2820) 11 Containers (2821) #of Containers: TA#' /-f>?5-) g O 2 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: 55,Tank (2820) ElContainers (2821) #of Containers: TA#n: )D�l 3 Product Type: .�JC/ Total Capacity:/d 00 gallons y (per tank or cumulative for containers by product type) Install Date: 'P✓7 4/' r Tank (2820) El Containers (2821) #of Containers: TA#: 4 � ) Product Type: Total Capacity: / / gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) containers (2821) #of Containers: TA#: 3 5 Product Type: �LZTP/� �i'� Total Capacity: Z DO gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 1 O S gallons Total Capacity for Site: �� gallons Comments: EHD Inspector: Reviewed Date: Entered Date: By Initial: ` , 0 O By Initial: A A kr"qQ *Aboveground storage t nk 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