BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209)468-3433 Web:www.sigov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: Page �- of Facility Addre s: City: Y/ Inspection to 1 FA#: PR#: Program lent: Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum ?1,320 gallons in tanks` and containers". Complete one box for each tank or each cumulative container product type. ❑ Tank (2820) aContainers (2821) #of Containers: TA#: 1 Total Capacity: '2 ` gallons Product Type: �/ % "1 r f� ��/ J (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) I/Containers (2821) #of Containers: �_ TA#: 2 -� Product Type: X�14 Q�f Total Capacity: S gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ 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#: 5 Total Capacity: Product Type: p y: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 00 gallons Total Capacity for Site: gallons Comments: EHD Insec Reviewed Date: Entered Date: By Initial: By Initial: g "Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of p roleum. "Container means a storage device designed to be moved when full. EHD 28-01 09/12/08 AST SURVEY FORM