Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> Page '?,of <br /> Facility Address: Va <br /> City: 1Ins�pe <br /> c 3tK;�� <br /> FA#: 5- PRW: Program Elementh <br /> Tank/Container Information <br /> Completefo II sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks*and containers". <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: /9,6W7`712 <br /> 1Product Type: <br /> Total Capacity: &tv gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) ❑ Containers (2821) #of C iners: TA#: 051 $-7- <br /> 2 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers 0 product type) Install Date: <br /> kTj <br /> ank (2820) El Containers (2821) #of Containers: TA#� 1 $"Z`7 <br /> 3Product Type: -� <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> 1�1/Tanlk (2820) ❑ Containers (2821) #of Containers: TA( <br /> #: n /2 ?7_3 <br /> Total Capacity: <br /> 4 Product Type: zlxxgl � ?7/- <br /> S� gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA <br /> 5 Total Capacity: oe,4D gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: 5S6 gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> By Initial: By Initial: C <br /> *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleu <br /> **Container means a storage device designed to be moved when full. <br /> EHD 28-01 AST SURVEY FORM <br /> 09/12/08 <br />