Laserfiche WebLink
SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTM <br />600 East Main Street, Stockton, CA 95202-.,-z9 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br />ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br />Facility Name: <br />1%n/Sg Al DN <br />Page a✓ of <br />! /2113 <br />pjl <br />Facility Address: <br />• ?' <br />City: <br />L��iPo <br />Inspect' n Dat <br />2 t.6 <br />FA #: <br />PR #: <br />Program Element: <br />Tank/Container Information <br />Complete for all sites with cumulative aboveground storage <br />of petroleum >_ 1320 gallons <br />in tanks and containers over 55 gallons. <br />Complete one box for each tank or each cumulative container product type. <br />❑ Tank (2820) E/Containers (2821) <br />#of Containers: <br />A#:_ 7�j�_ <br />(>250 gallons) (>55 gallons and <250 gallons) <br />1 <br />Z SO <br />Product Type: Qar_� <br />Total Capacity: g <br />Install Date: <br /> <br />(per tank or cumulative for containers by product type) <br />❑ Tank (2820) Containers (2821) <br />#of Containers: <br />TA#: a,51(, ?3 <br />2 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Product Type: II <br />Total Capacity: /so gallons <br /> <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />❑ Tank (2820) [Et/containers. (2821) <br />#of Containers: <br />TA#: 195-1 & :7 40 <br />3 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />_ <br />Product Type: Q,t� <br />Total Capacity: / fl gallons <br />Install Date: <br /> <br />(per tank or cumulative for containers by product type) <br />IR/Tank(2820) ❑ Containers (2821) <br />#of Containers: <br />TA#: ,h lGQ % / <br />4 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Product Type: r(z <br />T <br />Total Capacity: 'LO & gallons <br />,'A`& <br /> <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />❑ Tank (2820) Containers (282 1) <br />#of Containers: <br />TA#: A <br />5 <br />(>250 gallons) (>55 gallons and <250 gallons) <br />Product Type: <br />Total Capacity: / �—� gallons <br /> <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />Total Capacity this Page: 2 3, <br />gallons <br />Total Capacity for Site: 5 X gallons <br />Comments:8 3 9. t f p j' <br />M 4 VIt I c ­_Ar 5,4AI S o OV <br />1 Z - <br />3 -- <br />Al <br />�iil�S'� 7A�kSj C 0 A <br />Nr— <br />1/t fc Y <br />QfilP 7 El/ L66P <br />fl <br />EHD Inspector: <br />(� r <br />Reviewed Date: <br />By Initial: VA(Q.'j,Sr� <br />Entered Date: <br />By Initial:0 <br />EHD 28-01 <br />01/16/08 <br />S <br />l0 <br />