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SAN JOAQUIN COUNTY INVIRONMENTAL HEALTH DEPARTMENT •� 000 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 iOt Facility Name: y • I G- &J A +. Page of Facility Address: City: Inspection Date: TP FA #: a o i a S- PR#: $1 a a Pr gr m Elem t: 2 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum > 1320 gallons in tanks and containers over 55 gallons. - Complete one box for each tank or each cumulative container product type. Tank (2820) ❑ Containers (2821) #of Containers: TAA; (>250 gallons) (>55 gallons and <250 gallons) 1 Total Capacity: •©` 1) gallons Product Type: (per tank or cumulative for containers by product type) Install Date: U- ank (2820) ❑ Containers (2821) #of Containers: TA#: l� (>250 gallons) (>55 gallons and <250 gallons) 2 Product Type: Total Capacity: 0�04FV gallons (per tank or cumulative for containers by product type) Install Date: ank (2820) ❑ Containers (2821) #of Containers: TA#: ks!!�j i�69 y_ 3Product (>250 gallons) (>55 gallons and <250 gallons) Type: Total Capacity: _�-° e) gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and <250 gallons) 4 Product Type: Total Capacity: gallons Install ate: (per tank or cumulative for containers by product type) ❑ Tank (2820) ❑ Containers (2821) #of Containers", TA#: 5 (>250 gallons) (>55 gallons and <250 gallons) Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) Total Capacity this Page: p -D gallons FTotat Capacity for Site:�� gallons LT Comments: D EHD Inspector: Reviewed By Initial: Date: I /� ✓L Entered Date: By Initial: ,pQ� EHD 28-01 01/16/08