BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY - t s NVIRONMENTAL HEALTH DEPARTMENT* 600 East Main Street, Stockton,CA 95202-3029 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: /? S(�l Page of Facility Address: City: Inspection ate: Y' sNra w �- / 3 ) ) z �1 FA#: 0D/00V /SSS PR#: Program El ent: S '2- g rr� Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: Total Capacity: gallons (per tank or cumulative for co iners by product type) Install Date: ❑ Tank(2820)A(95gaUo (2821). #of Containers: TA#: (>250 gallons) 50gallons) 2 Product Type: Total Capacity: gallons (per tank or cumulativet type) Install Date: �,/� IV ❑ Tank(2820) ❑ Containers 2821) #of Containers:I r' TA#: (>250 gallons) (>55 gallons and Q5 allons) 3 Product Type: Total Cap city: g ons (per tank or umulative for containers by product typ Install Date: ❑ Tank(2820) ❑ Containers (2821 #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank(2820) ❑ Containers (2821) f Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 5 roduct Type: Total Capacity: gallons tall Date: (per lank or cumulative for containers by product type) Total Capacity this Page: gallons Total Capacity for Site: gallons Comments: t/ r S T l v Irk- G,C-A 5'i u P �upptXo or tZrga WI EHD Inspector: Reviewed Date: Entered Date_ By Initial: VA .1,JA By Initial: EHD 28-01 01/16/08 1