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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMEN'. 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: O CN Ll k G � page _of 7/ FaCility AAA-4- City Inspect i n Date: 5 i 5- K ?_ a 2 PR#: Program Element: Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum >1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. Tank(2820) ❑ Containers (2821) #of Containers: -'A#: L,2 17 J 1 y (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: Total Capacity: Z000 gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) 4/Containers (2821) #of Containers: 7 TA#: rj ) (>250 gallons) (>55 gallons and<250 gallons) 2Product Type: � f'�,- Total Capacity: ) gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank(2820) Containers (2821) #of Containers: TA#: a`71 -j u�� (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: Total Capacity: / �9- gallons (per tank or cumulative for containers by product type) Install Date: L?' Tank (2820) ❑ Containers (2821) #of Containers: TA#: d,�T/ 711 '7 (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: Total Capacity: '2- (per tank or cumulative for containers by product type) Install Date: Tank(2820) ❑ Containers (2821) #of Containers: TA#: /? (>250 gallons) (>55 gallons and 250 gallons) 5 Product Type: Total Capacity: O aZ-�F' gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: 5 gallons Comments: EHD Inspector: (TIReviewed Date: Entered Date: By Initial: VTj J,Ijp-V`b By Initial: gP EHD 28-01 01/16/08