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• • SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMEN'-- 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: S c�r� Tq'r-f �, O - Qtr t,— PageL of Facility Address: d City: Inspection Datq: n - L l✓1, / c 0 FA #: PR #: Progr m Element: 93 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: TA#: D,5 -j5 "S- 1 50 gallons)(>55 gallons and <250 Ilons) Product Type: Eq(' q-, b L. Total Capacity: SZ ( � 1--ga Ions (per tank or cumulative fdr contain by product type) Install Date: X Tank (2820) El Containers (2821) #of Containers: TA#: ��,q L 2 (>250 gallons) (>55 gallons and <250 gallons) Product Type: � I' 9 �} `l (n �9'�'� /9� yeti Total Capacity: 3 gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) rContainers (2821) #of Containers: TA#: 3 (>250 gallons) >55 gallons and <250 gallons) Product Type: L V r a O Z � Total Capacity: 2 -� S gallons (per tank or cumulative for containers by product type) Install Date: ❑ 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 Install Date: (per tank or cumulative for containers by product type) Total Capacity this Page: 2 gallons Total Capacity for Site: b S j Z Lgallons Comments: EHD ector:Reviewed By Initial: Date: Entered Date: By Initial: ll -f 1,9 aA EHD 28-01 01/16/08