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SAN JOAQUIN COUNTY I� .TfffU <br /> �ANVIRONMENTAL HEALTH DEPARTMEN\ j <br /> 00 East Main Street;Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sigov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> O Z U 6- 9 C9z Page of <br /> Facility Address: City: <br /> Inspecti�Date- <br /> :W5,0 0 ; <br /> FA#: <br /> PR#: <br /> 7 <br /> �9� Program Element: <br /> 000S'�oz ' <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum �-1320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. .. <br /> ank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: <br /> Total Capacity: m fl gallons <br /> p at `� <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) .(>55 gallons and<250 gallons) <br /> 2 Product Type: <br /> Total Capacity: ®D gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 � Product Type: . <br /> Total Capacity: gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) .i (>55 gallons and X250 gallons) <br /> 4 Product Type-, <br /> Total Capacity: gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank(2820) El Containers (2821) #of Containers: TA#: <br /> (?250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: /Cp© � gallons Total Capacity for Site: �a 17 d gallons <br /> Continents: F <br /> EHD Inspector: Reviewed t : f Entered Date: f� + <br /> c -1 By Initial:' ��f(� By Initial: <br /> 41 <br /> EHD 28-01 <br /> 01/16/08 <br />