Laserfiche WebLink
q,n)Z <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMEN' <br />o00 East Main Street, Stockton, CA 95202 -302 - <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Weh: www.sjgov.org/ehd <br />ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br />Facility Name: <br />C ( <br />Page of <br />MLD <br />—L— <br />Facility Address: c-11 _, City: <br />W o_ 12c� ?��''�'r` �' c, [�197-716 <br />n Da: <br />FA #:w 5(c:;1PR <br />11 <br />#: <br />osa <br />Program Element: <br />2 8 3 L_ <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 />Complete one box for each tank or each cumulative container product type. <br />Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br />1 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Product Type: � % 2sPiL <br />Total Capacity: 2 0 6 O 0 gallons <br />, <br />(per tank or cumulative for containers by product type) Install Date: <br />❑ Tank (2820) %Containers (282 1) #of Containers: TA#: <br />2 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Product Type: � ¢ (C r <br />Total Capacity: � S gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />❑ Tank (2820) XContainers (2821) #of Containers: TA#:�� (S$` <br />3 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Product Type: e&!! r" (� �, <br />Capacity: <br />Total Capacity'266 gallons <br />Install Date: /" <br />(per tank or cumulative for containers by product type) <br />❑ Tank (2820) Containers (282 1) #of Containers: TA#: /�' �' j 771 <br />4 <br />(>250 gallons) (> gallons and <250 gallons) e <br />Product Type: <br />Total Capacity: 1,00 gallons <br />Install Date: , <br />(per tank or cumulative for containers by product type) <br />l Tank (2820) Containers (2821) #of Containers: I TA#: 1951 "% /!?0 <br />5 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Product Type: V Se. 0 a i L ( TAALI) <br />Total Capacity: k O D gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />Total Capacity this Page: 3s— gallons <br />Total Capacity for Site: S gallons <br />Comments: <br />�. 1 <br />EHD In tor: <br />V � <br />Reviewed Da e: ��// <br />By Initial: ,?. A <br />Entered Date 'J <br />By Initial: �L <br />EHD 28-01 <br />01/16/08 <br />