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SAN JOAQUIN COUNTY <br /> v 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: /' CC <br /> �c [`ATS I C Fly O 1`C1Cik t Page of <br /> Facility Address: City: Imp e ion Date: <br /> owl --Ft Auh � 002'1 10 'z <br /> FA#: ^' PB#: Prog am Element: <br /> Vrn'ry <br /> L -) <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum >:1320 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: TAM A h/ 4 02 7F'7 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> l Product Type: L t a + I fJ 4 C peat" O V aA l cxt <br /> Total Capacity: ?0 j mTo gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> N Tank(2820) ❑ Containers (282 1) #of Containers: TA#: Z (RS( (Qo27 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: [,i 12vtb tfy}`K-OL <br /> Total Capacity: 30 1 04o gallons <br /> (per tank or cumulative for containers by producttype) Install Date: <br /> N Tank(2820) ❑ Containers (2821) #of Containers: TAM 3 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: Ll Q,V f h Afnbv� k a,6 2 <br /> Total Capacity: 2 D 1000 gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> IX Tank (2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: L'i QuIp <br /> Total Capacity: U W gallons <br /> (per tank or cumulative for containers by product type) Install Date' <br /> )l Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: C r U S G tr- (5 t-L 'Z 2 <br /> Total Capacity: Z O� � gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons I Total Capacity for Site: gallons <br /> Comments: <br /> B/a /1— c e <br /> q,,7z' 0-I r4 g All P A t tN.- -Q, <br /> ree 9n- v1G �r✓� tc� L <br /> EHD In r. Reviewed pate q Entered Date: <br /> By Initial: S I C� By Initial <br /> EHD 2"I V I s <br /> 01/16/08 <br />