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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT JO East Main Street, Stockton, CA 95202-302, Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: D/ L Page � of Facility Address: 3000 L A✓ A l/'F City: �S GA La� Inspectir te: 51 �'1 FA #: ooa 9628 PR #: Program Element: 281 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) ##o f Containers: TA#: g (>250 gallons) (>55 gallons and <250 gallons) 1 Product Type:�/A 57 0 � Total Capacity: '?Q gallons Install Date: (per tank or cumulative for containers by product type) I�f Tank (2820) 12 Containers (2821) #of Containers: TA#: 2 (>250 gallons) (>55 gallons and <250 gallons) � Product Type: Total Capacity: 2 % gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) (�ntainers (282 1) #of Containers: TA#: le ? S 3 (>250 gallons) (>55 gallons and <250 gallons) i Product Type: Total Capacity: 2� gallons 01 Install Date: (per tank or cumulative for containers by product type) ank (2820) Containers (2821) #of Containers: TA#: 2,4V L, � 4 (>250 gallons) (>55 gallons and <250 gallons) / -2- Product Type: (� � Total Capacity: % gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) Containers (2821) #of Containers: Z TA#: j'26-1 os - 5 (>250 gallons) (>55 gallons and <250 gallons) Product Type: Total Capacity: Z ) gallons Install Date: (per tank or cumulative for containers by product type) Total Capacity this Page: 136-5' gallons Fotal Capacity for Site: /3 gallons Comments: EHD Inspector: " ReviewedDate: By Initial: vl vA` f 6d Entered Date: By Initial: VI/P5,- EHD 28-01 01/16/08