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SAN JOAQUIN COUNTY <br /> *ENVIRONMENTAL HEALTH DEPARTMENO <br /> + 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> A <br /> ABOVEGROUND PETROLEUM STORAGE: PROGRAM SURVEY/FORM <br /> Facility Name: ?- Page { Of <br /> 3 its ,Ci✓ <br /> Facility Address;3 i^D ,S C &Z nN�Z Jr(/__0/ Inspel[i ryD O1 <br /> FA#: Y /Y PR#: (' Prn`Iora VI o r• <br /> 771 1 P5aW422 935 <br /> Tank/Container Information <br /> Complete fo all sites with cumulative aboveground storage of petroleum 21320 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 /> Total Capacity: O 0 0 gallons Product'I'ype: Z2 <br /> (per tank or cumulative for containers by product type) Install Date: <br /> *'<nk (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) �_ — <br /> 2 Product Type: <br /> Total Capacity: J so gallons v <br /> (per tank or cumulative for containers by product type) Install Date: i <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and X250 gallons) ' <br /> 3 Product Type: <br /> Total Capacity: 2-00 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) / -rte f <br /> 4 �y �,� Product Type: T D <br /> Total Capacity: �gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date' <br /> Total Capacity this Page: © gallons Total Capacity for Site: Z 9 gallons <br /> Comments. <br /> EHD Inspector. Reviewed - f Date: Entered Date' <br /> By initial: 1 ,RSI l`_10,0 8y Initial: /IO[AO <br /> EHD 28-01 <br /> 0 f/l6/08 <br />