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SAN JOAQUIN COUNTY AW JWNVIRONMENTAL HEALTH DEPARTMEN1 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: M .� Page of Facility Address: city. Inspects Date z/ N 6 fJ S 2- FA#: 'f— ^ PR#8 5x1313 _ Progra Element: �F3) z(f J Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum z 1320 gallons in tanks and containers over 55 gallons. Com lete one box for each tank or each cumulative container product type. ❑ Tank(2820) Containers (2821) #of Containers: L?/TA#: D,!/ 7 I 0 (>250 gallons) (>55 gallons and<50 gallons) 1 Product Type: /+f 0T6/i 6/ Total Capacity: C �b gallons (per tank or cumulative for containers by product type) Install Date: Tank(2820) ❑ Containers (2821) #of Containers: .TA#: d 7/ (>250 gallons) (>55 gallons and 250 gallons) 2 Product Type: Total Capacity: J O e gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<50 gallons) 3Product Type: 7 Total Capacity: Zsa gallons (per tank or cumulative for containers by product type) Install Date: / ❑ Tank (2820) l21-1<ontainers (2821) #of Containers: I TA#: (>250 gallons) (>55 gallons and<50 gallons) J } 4 Product Type: �/7/ / Total Capacity: S f gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (282 1) #of Containers: TA#: Pj,-ti—I 7/ A114 (>250 gallons) (>55 gallons and<50 gallons) 5 Product Type: D Total Capacity: �,5 gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: Ot D gallons Total Capacity for Site: gallons Comments: EHD Inspector: s Reviewed Date: Entered Date: r By Initial: � �,�(,ba(( By Initial: $-�� EHD2MI 01/16/08