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 /> l_/cc.� • �/ C:/�S /V i,�l�j�'%�-� Page of <br /> Facility Address: City: Inspect n Dap: <br /> n <br /> FA#: PR#: Program Element: <br /> Tank/Container Information <br /> Complete for all 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#: <br /> 1 Total Capacity: Product Type: <br /> ��>0 gallons <br /> (per tank or cumulative for containers by product typc) Install Date: <br /> #of Containers: TA#: <br /> l:Y I ank (2820) El Containers (2821) - <br /> 2 Total Capacity: Z1,­e) gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Er-Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 3 Product Type: <br /> Total Capacity: U gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> #of Containers: TAM'Tank (2820) El Containers (2821) <br /> 4 �, Product Type: <br /> Total Capacity: 2�of) 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: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: ( gallons Total Capacity for Site: etz gallons <br /> Comments: <br /> EHD Inspector Reviewed Date: .c, Entered Date' i <br /> (t By Initial `_a - \ By Initial: J y <br /> "Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. <br /> "Container means a storage device designed to be moved when full. <br /> EHD 28-01 AST SURVEY FORM <br /> 09/12/08 <br />