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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />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 -R1 iRvw CnOee <br />nvvvcy1UU11U �widye tanK means a tanK that has the capacity to store 55 gallons or more of petroleum. <br />"Container means a storage device designed to be moved when full. <br />EHD 28-01 <br />09/12/08 AST SURVEY FORM <br />Facility Name: <br />Q C7� <br />Page of <br />Facility Address: City: <br />Ins pe tion Da e: <br />FA #: P #: <br />Program EI menta <br />2-(?3-2— <br />g3ZTank/Container <br />/ice O / a / D 5� <br />�J 'T <br />Tank/ContainerInformation <br />Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks` and containers". <br />Complete one box for each tank or each cumulative container product type, <br />Tank (2820) El Containers Containers: TA#: Containers (2821) 91.,' ale <br />J <br />Total Capacity U ' gallons e06,Product Type: <br />tank <br /> <br /> <br /> � <br />❑ Tank (2820) Ldontainers (2821) #of Containers: L(.,tO TA#: Q,15 --j <br />2 <br />Total Capacity: —71+ <S-0 gallons Product Type: <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />❑ Tank (2820) Containers (2821) #of Containers: 4000 TA#: <br />3 <br />Product Type: D GI C`j I <br />Total Capacity: 22b,aQo gallons <br />(per tank or cumulative for cont ners by product type) <br />Install Date: <br />❑ Tank (2820) XContainers (2821) #of Containers: 20 TA#: <br />4 <br />r(M I t <br />Total Capacity: O gallons Type: dl <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br />5 Total Capacity: S00 gallons Product Type: GL{, eSeL <br />(per tank or cumulative for containers by product type) � <br />Install Date: <br />Total Capacity this Page: 23 b O gallons Total capacity for Site: 26 (� S�� gallons <br />Comments: <br />o <br />- QS rl UYL6 <br />- - ltwry ► bas S I <br />I dK'� OI.Q-lo In s b 1 � <br />- � ea vD ca-✓bD>� S <br />EHD Inspector: Revie,6ed ( Date: <br />By Initial: . w l a�,t Q <br />Entered Date: J <br />By Initial: � / <br />/ /v <br />nvvvcy1UU11U �widye tanK means a tanK that has the capacity to store 55 gallons or more of petroleum. <br />"Container means a storage device designed to be moved when full. <br />EHD 28-01 <br />09/12/08 AST SURVEY FORM <br />