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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEN]`[ <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax: (209)468-3433 Web:www.sjgov.org/chd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> Gr 4nr bPage-2—of <br /> Facility Address:^ J Cit -y- Inspec on Date: <br /> •Jl O GL O�l �/`°Y(J'7 `✓p y: l /`A" ?. e! O <br /> FAN: r,�t �t Cl' Prog am Element: <br /> _l ! 2077 <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: TA#: (o0C�/!P�$� <br /> >250 gallons) (>55 gallons and<250 gallons) L <br /> 1 � Product Type: Coe/a./"' � l L �/� tiff f <br /> Total Capacity: !_-1-1 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: (�-2A1' U l L 1 Lf U <br /> Total Capacity: gallons <br /> (per tank or cumulative for con mets by product type) Install Date: �o <br /> X Tank (2820) ❑ Containers (2821) #of Containers: TA#: 0 / Ce a5t� <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: �2 A.r` 1j U41' h S A <br /> Total Capacity: 2�. ( gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) El Containers (2821) #of Containers: TA#: �sy j x,256 <br /> ` (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: r-�'4�'A— <br /> Total Capacity: A 01 2 gallons <br /> (per tank or cumulative for containers by product type) Install Date: / <br /> VTank (2820) El Containers (2821) #of Containers: TAM Go <br /> >250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: Au U i � <br /> Total Capacity: 10 b K- gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: -200 S�? gallons Total Capacity for Site: 2 Q gallons <br /> Comments: <br /> EHD Inspec Reviewed D : Entered Dat <br /> la 1 J By Initi 1:1 f�' 6 By Initial /�D <br /> EHD 2"1 <br /> 01/16/08 <br />