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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> "900 East Main Street, Stockton,CA 95202-302 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: / / 1 <br /> G!�'►� i r-C_, (�/�bTf UL�7 lv�J Page--27—of <br /> Facility Address:^ ,.I O r / City .y- Inspec on Date: <br /> J1 C.� A4J7 ! ( zj a? 0O <br /> FA#. '� PR#: Prog am�ment: <br /> 01 Li 6 � <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 /> Tank(2 ❑ Containers (2821) #of Containers: TA#: <br /> >250 gallons) (>55 gallons and<250 gallons) � <br /> (fin Product Type: Co e4 / L �V KJ <br /> Capacity: � gallons <br /> (per tank or emulative for containers by product type) Install Date: <br /> Tank (282 El Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> Product Type: (�jF�4t' U/ Z- �,S Ili <br /> of Capacity. _ g 3 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820 ❑ Containers (2821) #of Containers: TAM <br /> (>250 gall ) (>55 gallons and 7250 gallons) <br /> Product Type: &e A r r5 t-,.v ID S A F O <br /> Ota Capacity: 2'91 ( gallons <br /> (pia tank or emulative for containers by product type) Install Date: Q� <br /> X" Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> Product Type: 6) <br /> otal Capacity: Qj Z gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (282 ❑ Containers (2821) #of Containers: TA#: <br /> > 5 gall (>55 gallons and<250 gallons) <br /> Product Type: �� r/by r L P l u m <br /> O Capacity: ( O b,� gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: 3 S 21 gallons Total Capacity for Site: gallons <br /> Comments: <br /> L6 cQ /D <br /> EHD Inspec Reviewed / D : Entered at O <br /> J By Inti By Initial: <br /> EHD 2M I v <br /> 01/16/08 <br />