BILLING - Laserfiche WebLink

Home Browse Search

�• * : SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: K A ` Page of V S• __L Facility Address: city: x-03 !%sGR Lori 61-GGv r q �Y-E'� Inspecti n D te: ti 07 FA #: % PR #: Program Element O Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks* and containers`*. It Complete one box for each tank or each cumulative container product type. NI/Tank (2820) ❑ Containers (2821) #of Containers: TA#: —� 1Product T e: Total Capacity: /00047 gallons yp �� ") (per tank or cumulative for containers by product type) Install Date: El Tank(2820) M<ontainers (2821) #of Containers: TA#: 6' 2 Product Type: 61 Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: C) S-� gallons Total Capacity for Site: 0 C% S'' gallons Comments: EHD Inspector: Reviewed Date:,�,ry� By Initial: � v l Entered Date: By Initial: 191 *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. ` **Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08