BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street,-Stockton, CA 95202-3029 't Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.orglehd ABOVEGROUND PETROLEUM STORAGEPROGRAM SURVEY FORM . Facility Name: T . S. Page of Facility Address: City: Inspection te: e r. 1 0 S 91 / /j V Z1 FA#: PR#: Program Element: L 99a-- 2x Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks* and containers**. Complete one box for each tank or each cumulative container product type._ ank (2820) ElContainers (2821) #of Containers: TA#: 1 Product Type: 1QA Total Capacity: �iD gallons (per tank or cumulative for containers by product type) ..Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Total Capacity: gallons Product Type: ,f 1Q:S X / v� (per tank or cumulative for containers by product type) Install Date: "nk (2820) ❑ Containers (2821) #of Containers: TA,#: 3 Product Type: _ Total Capacity: � 3 �_ gallons (per tank or cumulative for containers by product type) :Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 8 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: �* (� gallonsl Total Capacity for Site: gallons Comments: ep EHD Inspector: Reviewed Date: l� ��'} Entered Date: By Initial: IV-' I I �np% By Initial: *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. "Container means a storage device designed to be moved when full. ' EHD 28-01 ii, AST SURVEY FORM 09/12!08 ;