Laserfiche WebLink
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 /> Paget of <br /> Facility Address: City: Ins ection Date: <br /> 'A <br /> FA#: PR#: Program 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 /> 12'Tank (2820) ❑ Containers (2821) #of Containers: I TA#: 19,rj o2 p p 1 g' <br /> Total C gallons <br /> 1 Product Type: VvLo1d fl I INA41 )Q4 ret <br /> (per tank or cumulative for containers by product type) IQC�h� tQvV�fowl <br /> Install Date: <br /> 'Tank (2820) #of Containers: TA#: �p <br /> 2 Total Capacity: _� K ty 'gallons Product Type: _S PAj'-a-— � �r► �ctnY-Ea�wt <br /> (per tank or cumulative for containers by product type) t'C&f <br /> Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 3 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 4 Product <br /> Total Capacity: gallons Type: <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 5 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: gallons <br /> Comments: <br /> UAA (AkA4j1AA0,rt _ ft:2X <br /> '^`�`,;1� - to + <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> Z 0• t) By Initial:2v n. 1 q_ By Initial: <br /> *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more 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 />