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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTME <br /> 600 East Main Street, Stockton,CA 95202-30c9 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: C co -L <br /> JG/A� Ivap Page of <br /> Facility Address: r/ City: Inspec <br /> t* D,a�e� <br /> F V 4F r C AI 7 <br /> FA#: PR#: Program Element: <br /> db aZ Z3 03 6 1 Z23v <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum >_1320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: �5-JCe c <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 0 o a,p Product Type: (,ZtttaA� <br /> Total Capacity: 2 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: / le 310 <br /> (>250 gallons) (>55 gallons and<250 gallons) � <br /> 2 Product Type: ka2(' <br /> Total Capacity: 2 o b o a gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> D4ank (2820) ❑ Containers (2821) #of Containers: TA#: n6j- lecl y l <br /> (>250 gallons) (>55 gallons and<250 gallons) rL <br /> 3 Product Type: Q! <br /> Total Capacity: 3 & 6, gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> IET/Tank(2820) ❑ Containers (2821) #of Containers: TAM /-9u,015-1 lPc31e�z <br /> 4 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> Product Type: <br /> Total Capacity: 3 0 o gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> CYfank (2820) ❑ Containers (2821) #of Containers: TAM 11511h'd lie 3Y-3 <br /> (>250 gallons) (>55 gallons and<250 gallons) O/ 7 <br /> 5 Product Type: Gr/NS� <br /> Total Capacity: 1� gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons FTotal Capacity for Site: / S d gallons <br /> crop <br /> Comments: <br /> EHD Inspector: Reviewed Date: 1 Entered Date: <br /> 0 _ By Initial: VIAJ (0.2 l� By Initial: <br /> EHD 28-01 <br /> 01/16/08 <br />