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SAN JOAQUIN COUNTY <br /> ONVIRONMENTAL HEALTH DEPARTMEi.. <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 /> O 0 r S Page-L—of <br /> Facility Address: City Inspects n D te- <br /> 2,s0 C • ��r�,�vGp L,9T 6 s 6/6Y <br /> FA#: -PR#: Program Element: <br /> o car) ? ( / y - - 2832 <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 /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<50 gallons) <br /> 1 2-P/0 DO Product Type: <br /> Total Capacity: �Vt gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: Dbi: 4 I1-7 <br /> B/rw <br /> (>250 gallons) (>55 gallons and<50 gallons) <br /> 2 Product Type: 0 f <br /> Total Capacity:;S 0 O gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ T 820) Ctinta' s (2 1) #of Contai rs: TA#: g <br /> (>25 allons) (>55 gallons d Q50 gall ) <br /> 3 Produ Type: n0 LR <br /> T al Capaci l gallon <br /> er tank or cumulativ or co iners byproduct type) I all Date: <br /> C� Tank (2820) ntainers(28 I� #of Containers: TA#: p,5!u go��o• 3,z7. c� <br /> (>250 gallons) (> allons d-FL gallons) <br /> 4 G�X LZ 7 5) Product Type: 01,e-', ( Aa-3, <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAM <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: _P-5-g--6r Z0775 gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHD Inspector: Reviewed I Dale; r– Entered Date: <br /> By Initial <br /> By Initial: <br /> V— <br /> EHD281 <br /> 01/16/08 <br />