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SAN JOAQUIN COUNTY 10 <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 SURVEY FOR <br /> [FA <br /> lit Name: <br /> ;7+� ' fJv'�l O � eSc N�P� 3 *Zfu <br /> Page�/ <br /> lity Addre C) + " � p City, TQ 6 0 - [( <br /> L T`ss: D Inspection Date: <br /> PR#: Progrraam EEl-emment: <br /> 2 ff 2) <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 11,320 gallons in tanks`and containers". <br /> Complete one box for each tank or each cumulative container product type. <br /> ,Tank (2820) ❑ Containers (2821) #of Containers: TA#: D.-5'2Do27 <br /> 1 Total Capacity: —ln-7) -L gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: Gfi't-OL( Sl On p <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#:45_c2Da7�5-- <br /> 2 Total Capacity: SO() gallons Product Type: aiesPL <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> ❑ Tank (2820) _C'Containers (2821) #of Containers: 3 TA#: ,9,haoa 7(r <br /> 3 Total Capacity: _ >(l allons Product Type: CAL <br /> (per tank or cumulative for-41 ersbyproduct type) Install Date: )2Z0 Aia1 -(/7 o.1 <br /> ❑ Tank (2820) PIContainers (2821) #of Cont ers: TA <br /> 4 Total Capacity: LJ-f) allons Product Type: 5p f <br /> (per tank or cumulative for c— orm iner`s by product type) <br /> Install Date: -WLPd.iU✓�l ,,� i <br /> ❑ Tank (2820) ZC Containers (2821) #of Containers: . TA#: <br /> 5 Total Capacity: allons Product Type <br /> (per tank or cumulative for A�7 itaindrs b�type) <br /> Install Date: L�.. dry\, •,S y� <br /> Total Capacity this Page: 2,C)'C gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHD Inspector: Reviewed Date: t t Entered <br /> (t By Initial:. rq 2 Y By Initial: Date: <br /> "Aboveground storage 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 />