BILLING (3) - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTM 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 Name: a/j Page l of Facility Address: City: InspectioryDate: Z D Z ogle r) C !-D A vF ST,� �/ Z�✓ �� FA#: D l / PR#- Program Element: r17 � kg Z93l Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum >1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. Tank(2820) ❑ Containers (2821) #of Containers: J TA#: 22 Ze 7/7 (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: _i2 Total Capacity: 2 0 06 gallons Install Date: (per or cumulative for containers by product type) Tank(2820) ❑ Containers (2821) #of Containers: A#: tQ 5/ LQ 7 1 (F? (>250 gallons) (>55 gallons and<250 gallons) 2 Product Type: Total Capacity: 6 0 y D gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacitythis Page: p p gallons Total Capacity for Site: -" gallons Comments: EHD Inspector: Reviewed Date: Entered Date: By Initial: wrJ �.�,�-O� By Initial: l� EHD 28-01 01/16/08