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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: <br />Woodbridge Irrigation District <br />Page 1 of <br />Facility Address: <br />18777 N. Lower Sacramento Rd. <br />City: <br />Woodbridge <br />Inspection Date: <br />Jun 17, 2011 <br />FA #: <br />FA0009319 <br />PR #: <br />52s��� <br />Program Element: <br />Tank/Container Information <br />Complete for all sites with cumulative aboveground storage of petroleum >_1,320 gallons in tanks* and containers**. <br />Complete one box for each tank or each cumulative container product type. <br />X❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: �) <br />11.000 <br />Product Type: 87 octane gasoline <br />Total Capacity: gallons <br />(per tank or cumulative for ataioer55y product type) i <br />1 s�� <br />Install Date: 1 �► <br />r <br />#of Containers: TA#: <br />❑X Tank (2820) ❑ Containers (2821) <br />2Product <br />360 Type: diesel <br />Total Capacity: gallons <br />(per tank or cumulative for co A ' e roduct type) Install Date: <br />❑X Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br />3 <br />80 Product Type: Oil <br />Total Capacity: gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />XJ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br />4 <br />60 Product Type: oil <br />Total Capacity: gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />1 <br />❑ Tank (2820) X❑,Containers (2821) #of Containers: 2 TA#: C� <br />5i' <br />110 j Product Type: oil <br />Total Capacity: o gallons <br />er <br />(per tank or cumulative for contains by product type) Install Date: <br />Total Capacity this Page: 1,610 gallons <br />Total Capacity for Site: 1,610 gallons <br />Comments: <br />AST survey done today. No Spill Prevention Control and Counter Measures Plan on site. <br />S_ <br />[b5 <br />EHD InspectorW <br />Reviewed -� Date:, <br />Fed Date: <br />By Initial: ` '1 �, 1 <br />tial: <br />*Aboveground storage tank means a tank that has the capacity to store 55 gallons or more OT petroleum. <br />**Container means a storage device designed to be moved when full. <br />EHD 28-01 REV 06/03/10 AST SURVEY FORM <br />