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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEI <br /> 600 East Main Street,Stockton,CA 95202-3( <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 /> 3 13� T VC- AUTO Pa <br /> ge Of <br /> Facility Address:�249 Al T PbO amity: 1 Inspe /Da <br /> /V J_OY✓ /N/�/N, <br /> FA#: PR#: Program Element: <br /> V I 5 -r � g 2- <br /> �3 `�- <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<50 gallons) <br /> 1 � C7 O Product Type: <br /> Z <br /> Total Capacity: 6 gallons <br /> (per tank or cumulative for containers by product type) Install Date: 'A �i3 <br /> C'Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) d � <br /> 2 :moi 9-7 <br /> O O ,J <br /> Total Capacity: p Product Type:gallons INv��rrJ K�°Ii1 <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Q'Tank(2820) ❑ Containers (2821) #of Containers: TA#: 067 /96�70 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: �r}ya�ml�i <br /> Total Capacity: gallons Install Date: �N�traiw! <br /> (per tank or cumulati or containers by product type) <br /> O Tank(2820) C�'Containers (282 1) #of Containers: TA#: ��((�16-17 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: O / (✓ <br /> Total Capacity: ro 0 gallons <br /> (per tank or cumulative for containers by product type) Install Date: l aN`l.NriuN <br /> [Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) ' r' <br /> 5Product Type: ty / <br /> Total Capacity: gallons Ut k ntti�nJ wl s '' <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: 1 gallons Total Capacity for Site: t gallons <br /> Comments: <br /> 7Y/ <br /> 46 it <br /> V <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> Ey Initial: wrJ 6/wO,) ay Initial: <br /> EHD 28-01 <br /> 01/16/08 <br />