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SAN JOAQUIN COUNTY NVIRONMENTAL HEALTH DEPARTMEN WO 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: pr 1n4.,r ce—I '�, -�L. C— -4r' Page - of Facility Address: City: Inspection Date: -7 6 s o �� -E f-1- -2--;- FA#: PR#: Program Element: Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum �t 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#: L 22 JE9 61 (>250 gallons) >55 gallons and<250 gallons) 1V.0 69 o Product Type: p 12-se— t Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) Ig Tank (2820) ❑ Containers (2821) #of Containers: TAM (>250 gallons) (>55 gallons and<250 gallons) 2 Product Type: Uvpi �a� Total Capacity: '2,e Q 0 gallons Install Date: (per tank or cumulative for containers by product type) Tank (2820) ❑ Containers (2821) #of Containers: TAM (>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 Capacity this Page: g r- p gallons Total Capacity for Site: <5>2— gallons Comments: �S 1.�V-e O/ G e-> — Ce .:m.' EHD Inspector Reviewed Date: Entered Date: By Initial: By Initial: Df� EHD 28-01 v 01/16/08