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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEN. � ) <br /> '� as <br />` 600 East Main Street,Stockton,CA 95202-302 <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 /> f <br /> Cpyi M UNM Page of <br /> Facility Address: City: [nspe n D e: <br /> eO G Say en t�-�, t <br />[ FA#: PR#: Program El eme t00 : <br /> k Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum z 1320 gallons in tanks and containers over 55 gallons. <br /> i <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank(2820) ❑ Containers { 1) #of Con:tai s: ; TA#- <br /> SO gallons) 55 gallons and X250 gallon <br /> 1 Product Type: AA 1-- <br /> Total acity: ( 3 U r gallons In 1 Date: : Q <br /> j (per tank or ulative for contain product type) <br /> Tank{282 ❑ Containers ( 1) #of Contain TA#: . <br /> -250 gallons) 5 gallons and 450 gallon <br /> 2 Product,Type: 4�0 L <br /> Tota city. Ions <br /> f (per tank or ulative or contaiierv. <br /> t typej Ins ate'. ao <br /> Tank (2820) ❑ Containers (2821)" #of Containers: TA#:zp <br /> (>250 gallons) (>55 gallons and 450 gallons) <br /> 3 Product Type: `j 2Se'L, 6 <br /> Total Capacity: 2 00 0 gallons Install Date: - 2,010 <br /> � <br /> (per tank or cumulative for containers by product type). <br /> Tank(2820) ❑ Containers (2821) #of Containers: TAM z9b <br /> (>250 gallons) (>55 gallons and<250 gallons) <br />� 4 - Product.Type:. ID-6 Q y25 e L — [ <br /> Total Capacity: Z gallons n <br /> (per tank or cumulative for containers by product type) Install Date": �i 6 <br />{ Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> SD gallons) (>55 gallons and 450 gallons) <br /> t 5 Product Type: f ]e l <br /> Total Capacity: Z S f 04t b gallons <br /> 8 (per tank or cumulative for containers by product type) Install Date"' �(� <br /> Total Capacity this Page: S' vpp gallons Total Capacity for Site: U (3 0 gallons <br /> 1. <br /> 1 v. r <br /> Comments: n � <br />� C . <br />{ Ib s 0 0 Qoz2��Le_a_-a�Z <br /> J- -71M I vt ' <br /> END In ewed ."Daae: Entered k <br /> rl3y-Initial: y--=By.lnitial: <br /> 01/16/08 <br />