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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> `K00 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 /> �j �Lrrrl � Ct7ASk !"11C�k1`,1\, PageTof <br /> Facility Address: City: Inspe tion Date: <br /> � bel Tt �Lh � � f 2� �0 t, <br /> � <br /> FAPit#: Program Element: <br /> V I 1z <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 /> (2820) El Containers (2821) #of Containers: TA#: I tg h/(o a77 <br /> allons) (>55 gallons and<250 gallons) <br /> Product Type: L i G3-, 1 Q 4 C,0114 � E V eA f cA t <br /> Total Capacity: �O �J gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> T (2820) El Containers (2821) #of Containers: TAM 2 GR5( L?oZ7g <br /> >25 ga ) (>55 gallons and<250 gallons) <br /> tllProduct Type: L i 12vth 61p42T l k vw htcl, <br /> Total Capacity: allons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> IRT (2820) ❑ Containers (2821) #of Containers: TA#: 3 06j fl a,2`t' <br /> 5 s) (>55 gallons and<250 gallons) <br /> Product Type: Lj QrVfFj 8 fplyf <br /> rTotal Capacity: 2 D(!J 0 D gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> I, Tank ( 20) ❑ Containers (2821) #of Containers: TA#: �S/ (Q�$L <br /> rotTal <br /> (>55 gallons and Q50 gallons) <br /> ((((������\ Product Type: W Q�✓ o 4dntvi - (apacity: 0" gallons <br /> or cumulative for containers by product type) Install Date: <br /> 1 Tank( 820) ❑ Containers (2821) #of Containers: TA#: <br /> >J„S gal (>55 gallons and<250 gallons) �- <br /> YVI 1V/ III///���lllllV//A�A��\ Product Type: Cr USWr- r) tZ 2 2 <br /> otal Capacity: 2 O� � gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: .tL Za ` gallons I Total Capacity for Site: gallons <br /> Comments: <br /> M &An4 I4Irn l(A S <br /> ' All P Ute^ kJQ1Lf A N-Q� <br /> C'QC re-IJ NlG rin {N t <br /> Pr <br /> EM Ins r: Reviewed pate Entered Date: <br /> By Initial: t] ( By it <br /> EHD 2MI (` <br /> 01/16/08 <br />