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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: n 1-e k T Page ___L_ of Facility Address: S3 �- L�wie� City: % Inspection Date: -7 .� `sc��,o� z� p FA #: 7 3 / 3 PR #: ©�53 Program Element: 2- 8 3 D 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) El Containers (2821) #of Containers: TA#: Dh l $ 529 1gallons Total Capacity: Product Type: (per tank or cumulative for containers by product type) Install Date: &-Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2• Total Capacity: � _ �r gallons t7 Product Type: Z (per tank or cumulative for containers by product type) Install Date: ank (2820) D Containers (2821) #of Containers: TAr#: 3 Total Capacity: o-cr- gallons Product Type: (per tank or cumulative for containers by product type) Install Date: 4kfank (2820) ElContainers (2821) #of Containers: TA#: 4 Total Capacity: -? t� gallons Product Type: (per tank or cumulative for containers by product type) Install Date: #of Containers: TA#: g ❑ Tank (2820) ontainers (2821) 5 Total Capacity: gallons Product Type: 444.9 (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: Z 3 S-: gallons Total Capacity for Site: gallons Comments: EHD Inspector: ReviewedDate: t - By Initial: it) .)0'00) Entered By Initial: Dat e: *Aboveground storage tank 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