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SAN JOAQUIN COUNTY <br /> INVIRONMENTAL HEALTH DEPARTMEN. <br /> d00 East Main Street,Stockton,CA 95202-302y <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 /> S 7-c, t,IC. TO yv v Af/ G�'A �i Z/Tl/.-/7/- r,'-.7 j�l S'?�l�iT Page 7/ of—3-- <br /> Facility Address: City: Inspection Date: <br /> FA#: PR#: Program Element: <br /> oo *60 1 a 7;F o <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum z 1320 gallons in tanks and containers over 55 gallons. <br /> Com Tete one box for each tank or each cumulative container product e. <br /> ❑ Tank(2820) Containers (2821) #of Containers: s TA#: �I f� <br /> (>250 gallons) (>55 gallons and<250 gallons) ` <br /> 1 Gj <br /> Total Capacity: Z?.r gallons Product Type: D I <br /> (per tank or cumulative for containers by product type) Install Date: <br /> El Tank(2820) E Containers(282 1) #of Containers: TA#: 5 / <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: T ',p� <br /> Total Capacity: gallons I✓` <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) m Containers (282 1) #of Containers: l TA#: / qI <br /> (>250 gallons) (>55 gallons and<250 gallons) �I <br /> 3 Product Type: z12 p'yA y/ <br /> Total Capacity: 5s� gallons Install Date: I� <br /> (per tank or cumulative for containers by product type) <br /> ElTank(2820) Pa�Containers (2821) #of Containers: _ TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: 4 7'/C II,�l <br /> Total Capacity: �-a gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) Containers (2821) #of Containers: /4 TA#: 19, ,57/73 3 4 ''nn <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: wj s 722 2 <br /> Total Capacity: 1-17 0 gallons �I <br /> Install Date: <br /> (per tank or cumulative for containers by product type) <br /> Total Capacity this Page: s r gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> By Initial: By Initial: <br /> EHD 28-01 <br /> 01/16/08 <br />