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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 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: <br /> eN P/L, /�( Page Z of <br /> Facility ddre City: Inspe Ion Da e: <br /> L 3 6 la <br /> FA PR M Frog am Element: <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks*and containers**. <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank (2820) ❑ Containers (2821) #of Containers:' I TA#: �( qq-7 <br /> Capacity:1 Total Ca gallons Product Type: �f_ V t5r4,)I /Z OiL <br /> (per tank or cumulative for containers by product type) &&v I l.ry vubQ,(� <br /> Install Date: u V n,w 0 <br /> Tank (2820) ❑ Containers (2821) #of Containers: I TA#: J qle <br /> Total Capacity: �� gallons $ <br /> 2 Product Type: 0V N r4v 1 %6 0/ L <br /> _ <br /> (per tank or cumulative for containers by product type) Install Date: U N VA o I1j/. � 2 VGG2 <br /> Ar Tank (2820) ❑ Containers (2821) #of Containers:r ' TA#: <br /> 3 Total Capacity: Product Type: b{�-/� /'�tJ bl Z <br /> p y: gallons <br /> (per tank or cumulative for containers by product type) Install Date: U N 'l own <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: Z `) —1 <br /> 4 16 Product Type: �-i n f Liu I ! Z✓ / j, <br /> Total Capacity: S gallons � <br /> (per tank or cumulative for containers by product type) Install Date: Olytn.-� <br /> X Tank (2820) ❑ Containers (2821) #of Containers:, r TA#: (� <br /> 5 Total Capacity: gallons Product Type: nl--A'U GICp. �0"v- <br /> (per tank or cumulative for containers by product type) , 11/ - <br /> Install Date: 1!1",IJ"7 <br /> Total Capacity this Page: gallons Total Capacity for Site: 22, gallons <br /> Comments: All 1 Ar-t 01 <br /> l�2-✓ M <br /> EHD Inspector: Reviewed Date: Entered Date: h <br /> By Initial: By Initial: S dz /v <br /> *Aboveg ound storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. <br /> **Container means a storage device designed to be moved when full. <br /> EHD 28-01 <br /> 09/12/08 AST SURVEY FORM <br />