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SAN JOAQUIN COUNTY , <br /> :NVIRONMENTAL HEALTH DEPARTN <br /> 600 East Main Street,Stockton,CA 95202-.)025P <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM 7- <br /> �s <br /> Facility Name: 0 Ni <br /> Al f P-1-r IZ 1 6 t/7/On/ .1» O � Page -/--'Of <br /> Facility Address: City: Inspectio Date: <br /> 2- �- 600S• n/ A t <br /> FA#: PR#: Program Element: <br /> v ° I a31 052Z �25' 283y <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum Z 1320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: 19,6- 42p <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> /,.--/ <br /> 1 Product Type: l f <br /> Total Capacity: /2 U Cf-6 gallons `T, 65z <br /> (per tank or cumulative for containers by product type) Install Date: N �l ' , , <br /> II/Tank(2820) ❑ Containers (2821) #of Containers: TA#: LP pc, 7 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: 1--2A"�l <br /> Total Capacity: /Z,O O O gallons l ozafier:.BF <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3C;(; Product Type: <br /> Total Capacity: gallons <br /> Install Date: <br /> (per tank or cumulative for containers by product type) <br /> * (2820) Containers (2821) #of Containers: TA#: !' <br /> (> 5llons) > ggallons and<250 gallons) <br /> 4 Product Type: © l <br /> Total Capacity: gallonsloGcl}iLr�n <br /> VV <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: �S 9(� -P(� <br /> (>250 gallons) (>55 allons and<250 gallons) <br /> 5 1 Product Type: A t P F%1 <br /> Total Capacity: 6 gallons be t fi cyt: 7� i-F <br /> (per tank or cumulath or contain r uct type) Install Date: <br /> Total Capacity this Page: Im(o gallons Total Capacity for Site: x O'S-15 gallons <br /> Commne --p <br /> Jntss: er o� ( „_L^ owvht <br /> !1 �CGt,n�- tnlLj <br /> �t L <br /> 00 <br /> ho <br /> EHD Inspector: Reviewed Entered Dat : <br /> By Initial: L,&Date <br /> /7l By Initial: a�O <br /> EHD 28-01 <br /> 01/16/08 <br />