BILLING - Laserfiche WebLink

Home Browse Search

1y SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: _ J N / ��< f�� /61r�� l Page �, of Facility Address: �3 It J30 ZZA IVO �1�� City -3f� Ins��tiorr�"07 FA#: pR 196-oc r0>qseo Program/Elem/lD Tank/Container Information (/L Complete for all sites with cumulative aboveground storage of petroleum 11,320 gallons in tanks"and containers". Complete one box for each tank or each cumulative container product type. ElTank (2820) Ret�Containers (2821) #of Containers: _� TA#: 1 Total Capacity: 3 8s gallons Product Type: (per tank orcumulative for containers by producttype) Install Date: ElTank (2820) E!I/Containers (2821) #of Containers: TA#: 2 Total Capacity: 2 Z0gallons Product Type: (per tank orcumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Total Capacity: gallons Product Type: (per tank orcumulative for containers by producttype) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 6 S gallons Total Capacity for Site: p '4s gallons Comments: C 3 Z6- EHD Inspector: _ Reviewed �r,� Date: Entered Date: By Initial: VA Q By Initial: C 'Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. "Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08