BILLING - Laserfiche WebLink

Home Browse Search

~ 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: ; 63 �� A/ � /'1 -'>- Page � of / Facility Address: City: Inspection D te: FA#: #: Program Element: 6151530 ;� 11? 2 30 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum >_1,320 gallons in tanks` and containers". Complete one box for each tank or each cumulative container product type. C3/Tank (2820) ❑ Containers (2821) #of Containers: TA#- ' 1 Product Type: Total Capacity: % !0 (:1?0 gallons (per tank or cumulative'for containers by product type) Install Date: q,%Tank (2820) 11Containers (2821) #of Containers: TA#: 02D 2 Product Type: Total Capacity: �� gallons (per tank or cumulative for containersby product type) Install Date: ❑ Tank (2820) ❑Containers (2821) #of Containers: TA#: 1pS/ 13�( 3 7. f Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: C1 gallons Total Capacity for Site: Z 0 j gallons Comments: EHD Inspector: Reviewed Date: Entered Date: J By Initial: �_`� By Initial: `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