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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT'4010 <br /> 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: Page—L–of <br /> 'o NE5CR FARM-? <br /> Facility Address: a City: Inspection ate: <br /> -z -z695 S i ORT lVA A,-156CA ! /� °a <br /> FA#.- PR#: Program Elem nt: <br /> p 3 283 '✓ <br /> Tank/Container Information <br /> Complete for 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 containerproduct <br /> type. <br /> Tank(2820) ❑ Containers (2821) #of Colers: C� : <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Produc e: <br /> Total Capacity: 157 D 0-0 gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> IR/Tank (2820) ❑ Containers (2821) #of Co�tw[6ers: #: <br /> (>250 gallons) (>55 gallons and Q50 gallons) <br /> 2 Produe� ee. won 1 <br /> Total Capacity: gallons Install Date: <br /> (per tank or cumulative for containers by product type) , <br /> Tank(2820) L1 Containers (2821) #of Containers: TA#: D.517 5 /�(& <br /> (>250 gallons) (>55 gallons and<250 gallons) sti/J <br /> 3 Product Type: <br /> Total Capacity: / P b jO gallons <br /> (per or cumulative for containers by product type) Install Date: <br /> Tank(2820) ❑ Containers (2821) #of Containers: TAM -7 7 <br /> (>250 gallons) (>55 gallons and<250 gallons) //'� <br /> 4 Product Type: /rf0 S g <br /> Total Capacity: 1000 gallons Install Date: <br /> (petank or cumulative fm containers by product type) e.� <br /> L9'rtTank(2820) ❑ Containers(2821) #of Containers: TA#: ��/z7 p <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: 2yQ o gallons Install Date: <br /> (per tank or cumulative fm c tamers by product type) <br /> Total Capacity this Page: 'j 2, b 8 gallons Total Capacity for Site: 3 3 5-3 Q gallons <br /> Comments: <br /> EHD Inspector. _ Reviewed Date: Entered Date: <br /> By Initial: \\-117 C By Initial: 1( J a7 <br /> EHD 28-01 <br /> 01/16/08 <br />