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SAN JOAQUIN COUNTY i' n ` ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.orglehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name- BPP- 1JL �JG Page / of Facility Address: City: Inspectip n Datq: 2 `7 1f- go fl- N TO Y d2 i/i ,g FA fit: PR Q Pro Tlernlea : Lo& Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks*and containers". Completp one box for each tank or each cumulative container Broduct type. tank (2820) Containers (2821) #of Containers: `✓ TA#: 1 Product Type: Total Capacity: 1 / 0 gallons (per tank or cumulative for containers by product type) Install Date: U/Tank (2820) 2/containers (2821} #of Containers: , TA#: Ltd 2Product Type: ' �a 7 Total Capacity: 55 gallons - - (per tank or cumulative for containers by product type) Install Date: El Tank (2820) 1:1Containers (2821) #of Containers: TA#: 3 Total Capacity: gallons Product Type: (per tank or cumulative for containers byproduct type) - Install Date: ❑ Tank (2820) El-Containers (2821) #of Containers: TA#: 4. Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity:, gallons Product Type: (per tank or cumulative for containers by product type)' Install Date: Total Capacity this Page: gallons Total Capacity for Site: gallons Comments: 20Crpd 'i EHD Inspector; \ Reviewed Date: Entered Date: j' By initial: ' k-tit. By Initial: ( �� "'Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. r "Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12108