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SAN JOAQUIN COUNTY OLD <br /> � <br /> ?NVIRONMENTAL HEALTH DEPARTMEN'. v `� <br /> o00 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 /> T o c, o v GI !1l 11./TI�.S V)rA1/ Tage of <br /> Facility Address: City: Inspection ate: <br /> 2rb0 pv STS 3 0J' <br /> FA#: PR#: Program Element: <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<250 gallons) <br /> 1 Product Type: �iq�T� o i•C� <br /> Total Capacity: �:b d gallons <br /> (per tank or cumulative for containers by product type) Install Date. <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: Q 6- <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: <br /> Total Capacity: �/,O D 6 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) VContainers (2821) #of Containers: TA#: �5/ `fc3o27 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3Product Type: 141A�'j� <br /> Total Capacity: Z- so gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) M'Containers (282 1) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: .4? <br /> Total Capacity: 2.1 1) gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) Containers (2821) #of Containers: 3 TAM d 5—( 7�02Z <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: �eTy� O/ [/ <br /> Total Capacity: / e.,' gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: 0 gallons <br /> Comments: <br /> 3 <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> By Initial: p1 1 p.0 By Initial: I <br /> EHD 28-01 _1 <br /> 01/16/08 <br />