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" y 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 /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> C -nk"'A eN <br /> Page / of <br /> Facility Address: City: Inspection ate: <br /> C/ L ` 9 )q 2/-Z. 8 fo F <br /> FA#: PR#: Program Element. <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks*and containers". <br /> Complete one box for each tank or each cumulative container product type. <br /> Cl Tank (2820) ER/Containers (2821) #of Containers: TA#: f�'�l 9' 14! <br /> Total Capacity: ZG gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ElTank (2820) " Containers (2821) #of Containers: TA#: �' <br /> 2 Product Type: <br /> Total Capacity: 2-0-19 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ElTank (2820) Q'Containers (2821) #of Containers: 1 TA#: � j . <br /> 3 �e 0 Product Type: 4vl73' Vim° /7 <br /> Total Capacity: gallons _._ <br /> (per tank or cumulative for containers by product type) Install Date: <br /> EUI�ank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 4 Total Capacity: gallons Product Type: d <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ank (2820} El Containers (2821) #of Containers: T��A#: o�� <br /> 5 Product Type: <br /> Total Capacity: ��� gallons -- <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: ( gallons Total Capacity for Site: gallons <br /> Comments: <br /> NC <br /> / 4100 <br /> EHD Inspector; ` Reviewed Date: Entered Date: <br /> G By Initial: By Initial ko Fla, <br /> g <br /> *Abovegr and storage tank mea.*a tank that has the capacity to store 55 gallons or more of pe roleum. <br /> *"Containe eans a Stora vice designed to be moved when full. <br /> EHD 28-01 AST SURVEY FORM <br /> 09112/08 = 4 <br />