Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> *,.,,VIRONMENTAL 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: 6 Page - Ofy <br /> �F e S �R v G FG �✓� g <br /> Facility Address: 1 City: Inspec[i ate: <br /> GO V o� O <br /> FA N: PR#: Program Element: <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 /> Co ete one box for each tank or each cumulative container product type. <br /> ❑ Tank(2820) Containers (2821) #of Containers: �_ TA#: e9�010 q <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: a j==:� <br /> Total Capacity: ZS.0 gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> Tank (2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) G <br /> 2 Product Type: d < <br /> Total Capacity: Z0'0 O gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: <br /> Total Capacity: gallons Install Date: <br /> (per lank or cumulative for containers by product type) <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: <br /> Total Capacity: gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> Total Capacity this Page: Z 2 lr'd gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHD Inspector: A Reviewed Date: Entered Date: <br /> �! By Initial: By Initial: �,y <br /> EHD 28-01 V <br /> 01/16/08 <br />