COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

IRONMENTAL HEALTH DEPARTMENT ast Main Street,Stockton,CA 95202-30� Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjg_ .orglehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: LA Gil/�l�/✓Ll' t'� /� Z'/::: l= T�v c lGt,✓(r' Page of Facility Address: City: Inspection Date: G o .5- s #Pm i S o S I- 5'Tx FA#: ^ R L I PR#: Program Element: (/.� V Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum Z 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) #of Contai rs: TA#: (>250 gallons) (>55 gallons and<250 gallons) 1 Product e: Total Capacity: gallons (per tank or cumulative for containers by -duct type) Install ate: i Ili I I� ❑ Tank(2820) ❑ ContaineVtypeInstall ontainers: TA#: (>250 gallons) (>55 gallons and 2 ct Type: Total Capacity: (per tank or cumulative for containers by product Date: I ❑ Tank(2820) ❑ Containers/(2�82 #of Containers: TA#: (>250 gallons) (>55 gallons and<253 odi Type: Total Capacity: Ins 11 Date: (per tank or cumulative for containers by produ ❑ Tank(2820) ❑ Contain s (2821) #of Cont 'ners: TA#: (>250 gallons) (>55 gallons an <250 gallons) 4 Product T e: Total Capacity: gallons Install Date: (per tank or cumulative for contain by product type) ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) Total Capacity this Page: gallons I Total Capacity for Site: gallons Comments: t'1z 2! 1-!<--- EHD Inspector: Reviewed Date: Entered Date: By Initial: By Initial: I EHD 28-01 01/16/08 II�