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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 /> Y- J <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: Page .of <br /> ��T 6:1' A7 NG <br /> Facility Address: City: Inspecti n D D <br /> ITA-47— ` <br /> PR#: Proetam Erne-t: <br /> e�: <br /> TanklContainer Information <br /> Complete for all sites with cumulative aboveground storage of petroleum z 1320 gallons in tanks and containers over 55 gallons. <br /> Co tete one box for each tank or each cumulative container product type. <br /> Ili <br /> 11 Tank (2820), Containers (2821) #of Containers: . / TA#: <br /> ' (>250 gallons) (>55 gallons and C250 gallons) - . " O"& <br /> E 1 Product Type: 4" S'y' <br /> Total Capacity: �- ZT�fl gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> a <br /> El Tank (2820) U�Containers (2821) #of Containers:` � TA#: <br /> (>250 gallons) -(>55 gallons and-250 gallons) + <br /> 2 Product Type: OJ. <br /> Total Capacity: 2�4 0 gallons Install Date: <br /> (per tank or cumulative for containers byproduct type) <br /> ❑ Tank(2820) eContainers (2821) #of Containers:`_ TA#: . <br /> (>250 gallons) (>55 gallons-and<250 gallons)` <br /> 3 Product Type: 0./ <br /> i <br /> Total Capacity: Z gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank(2820) U216ontainers (2821) #of Containers!' <br /> TA#: <br /> j (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 . Product Type: J; /2-- d/ <br /> Total Capacity: l gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank(2820) ontainers (2821) #of Containers: TAM <br /> j (>250 gallons) (>55 gallons and<250 gallons) 0-67 <br /> 5 Product Type: ' I3r ' <br /> Total Capacity: Z10 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: -R-,�!= ='' gallons <br /> Comments: - _�- -- <br /> Ar_-NQS b R xr ZOO), <br /> n A/SOW <br /> Le ��r � A �� op /4 t-Ga �F <br /> s <br /> EHD inspector: Reviewed DAte: Entered Date: <br /> By Initial: t+ By Initial: L � <br /> EHD 28-01 <br /> 01/16/08 <br />