Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTME1• <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 /> zj y / � � � Page�_of <br /> Facility Address: City: Inspecti n Date: <br /> C7/ O() G/NJV,GC, <br /> FA#: PR#: Program Element: <br /> O a 04L © S/.!- 7 �-F' <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum z 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#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: <br /> Total Capacity: O 0 0 d 0 gallons <br /> (per tank or cumulative for c ntainers by product type) Install Date: <br /> L . Tank(2820) -0�rontainers (2821) #of Containers: --F- TA#: QsJ,�-Q��j <br /> (>250 gallons) (>55 gallons and<250 gallons) pp �� <br /> 2 Product Type: l't'd t C9 //� LL OL USG <br /> Total Capacity �G 4 gallons <br /> (per tank or cumulati for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> $ Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ILI .3010 <br /> Total Capacity this Page: L L. ' gallons Total Capacity for Site: gallons <br /> Comments: <br /> ��•l0 <br /> EHD Inspector: - Reviewed Datj: , Entered pf <br /> Date: <br /> By Initial: � t/ By Initial: 20? <br /> /� Q <br /> EHD 28-01 <br /> 01/16/08 <br />