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: C_ ()E'� 0 N 6- 7-9 v G �L{ W / N G Page of Facility Address: n ' City: Inspectiog Date b 0 l 0 � t D FA#: PR#: Program Element: 3 v L & 'Z $ 2-- Tank/Container Information Complete or all sites with cumulative aboveground storage of petroleum >_1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. VTank (2820) ❑ Containers (2821) #of Containers: yT A#: 7 (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: Total Capacity:,/ CJ O 0 D gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ontainers (2821) #of Containers: TA#: S5/'7,37 (>250 gallons) (>55 gallons and<250 gallons) 2 Product Type: Total Capacity: J 0y gallons (per tank or cumulative for containers by product type) Install Date: Tank(2820) ❑ Containers (2821) #of Containers: TAM 02 (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: r Q C Total Capacity: 3 6 a gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 0 44 O D gallons FTotai Capacity for Site: Q gallons Comments: EHD Inspector: Reviewed Date: Entered Date: By Initial: In ''� By Initial: / t n EHD 28-01 I !/ 01/16/08