BILLING - Laserfiche WebLink

Home Browse Search

v SAN JOAQUIN COUNTY v 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 ame: /; 1 iv S — rGR foo - GL i Page �of � Facility Address: City: Inspection Date: 1796 = No T(L /� a oa FA#: PR#: Program Element: /a 7/3 10 2S" Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks'and containers". Complete one box for each tank or each cumulative container product type. EM/Tank (2820) ❑ Containers (2821) #of Containers:h TA#: 1 Product Type: Total Capacity: !i/ gallons l (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM 3 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM 4 Product Type: Total Capacity: gallons (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: Z ( C) gallons Total Capacity for Site: 7�/� gallons Comments: ri 511 EHD Inspedoc Reviewed Date: Entered Date: By Initial: 1t��— By Initial: u B '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 08/12/08