Laserfiche WebLink
SAN JOAQUIN COUNTY <br />' ENVIRONMENTAL HEALTH DEPARTMEN, <br />r w 600 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: Q <br />9,418 ,kE L �� /✓ v/�/Z Tr 2 C//� G� �No C' ' <br />/ <br />Page of / <br />Facility Address: City: <br />V Ro G� za "'ICT ) <br />Inspectio Date: <br />/o�� 2 <br />FA #: <br />1c3 9 9 <br />PR #: <br />TD��$S-3`� <br />Program EI ment: <br />9 31 <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 />Comp ete one box for each tank or each cumulative container product type. <br />❑ Tank (2820) ontainers (2821) #of Containers: "Y TA#: D517q M <br />1 <br />(>250 gallons) (>55 gallons and <250 gallons)�� <br />Product Type: <br />Total Capacity: // P gallons <br />(per tankor cumulative for cont�ainer7 s by product type) Install Date: <br />El Tank(2820) PrContainers (2821) #of Containers: TAM e!!�6l 71 <br />2 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />� Product Type: <br />Total Capacity: S <br />gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />❑ Tank (2820) ontainers (2821) #of Containers: L TA#: <br />3 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Product Type: Al A/ <br />Total Capacity: `V gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />❑ Tank (2820) DI ontainers (2821) #of Containers: T #: Bu <br />4 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Product Type: <br />Total Capacity: � gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />Lam, ' (2820) ❑ Containers (2821) #of Containers: TAM <br />5 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Product Type: <br />Total Capacity: p e::� gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />Total Capacity this Page:Q gallons Total Capacitty for Site: i gallons <br />Comments: <br />EHD Inspector: <br />-T <br />Reviewed <br />By Initial <br />Date: <br />� Y' 0 <br />Entered Date: <br />By Initial: � <br />Lm <br />EHD 28-01 <br />01/16/08 <br />