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SAN JOAQUIN COUNTY <br /> NVIRONMENTAL HEALTH DEPARTMENT <br /> �'e0 East Main Street,Stockton,CA 95202-3029 <br /> *04 <br /> Telephone.(209)468-3420 Fax.(209)468-3433 Web.www.sjgov.orglehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> STC M D $ V) T o J. V G?4 fZ L°a ry a k d 1 Page of—L— <br /> Facility Address: City: Inspect' n Date: <br /> 795 S. way SIT X 2 o <br /> FA#: PR#: Progr m Element: <br /> 6a.2476-.:D, z 8 v <br /> Tank/Container Information <br /> Compl to 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 container product <br /> Tank(2820) ❑ Containers(2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> I <br /> Total Capacity: D O d gallons Product Type: <br /> (per ttaLank or cumulative for containers by product type) Install Date: O/ L <br /> M061k(2820) ❑ Containers (2821) #of Containers: TAM 195-i I (e <br /> (>250 gallons) (>55 gallons and Q50 gallons) <br /> 2Type: <br /> p00d s <br /> Total Capacity: 6 gallons Product <br /> (per tank or cumulative for containers by product type) Install Date: -� <br /> J�O<Ink(2820) ❑ Containers (2821) #of Containers: TA#: OU 7 <br /> 3 <br /> (>250 gallons) (>55 gallons and<50 gallons) <br /> C2 Product Type: <br /> D l/ <br /> Total Capacity: l O 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 /> 4 Product Type: <br /> Total Capacity: gallons Install Date: <br /> (per tank or cumulative for containers by product type) <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: D C?C) gallons Total Capacity for Site: 444(7 gallons <br /> Comments: <br /> EHD Inspector Reviewed Date: Entered Dat�e-y: <br /> By Initial: .�(a� By Initial: D 1(LpSr <br /> EHD 28-01 <br /> 01/16/08 <br />