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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL 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: <br /> L !"bW L� CO, �-�lSL �L�vl �"U' Page of <br /> Facility Address: City: Inspect'on Date: <br /> '2 by i VJ 4S O I N (6-ro"I ��� �'r�v� tL<,-Xl 2 261 CSG, q[116 <br /> FA#: PR#: Program Element: <br /> 7 6 66-AZ-2 7 7 3 cf <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum >_1320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. <br /> L� Tank (2820) ❑ Containers (2821) #of Containers: TA#: �2 Db l� 1�4 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: <br /> Total Capacity: Z S 6UU gallons VOU� i� <br /> (per tank or cumulative for containers by product type) Install Date' <br /> fR Tank(2820) ❑ Containers (2821) #of Containers: TA#: 3 051h-g-7 j) J <br /> (>250 gallons) V(>55alio and<V <br /> ons)2 �(�� Product Type: n Total Capacity: ons ` '71� <br /> (per tank or cumulative for containers by product type) Install Date: <br /> 14 Tank(2820) ❑ Containers (282 1) #of Containers: TA#: L(0,57 6-T 71 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: <br /> Total Capacity: �l°'� 00b gallons 611 �y��,��� b�����,�,,rZ7 <br /> (per tank or cumulative for containers by product type) Install Date: <br /> IX Tank (2820) ❑ Containers (2821) #of Containers: TA#: BcSI��$7,J 0 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: <br /> Total Capacity: .1 �0Dg 1 100 gallons Install Date: U N �� <br /> (per tank or cumulative for containers by product type) <br /> K Tank (2820) ❑ Containers (2821) #of Containers: TA#: �Pi -7/26X527 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 � Product Type: �� �-o(Total Capacity: 2 / 00 U gallogj <br /> ����� <br /> (per tank or cumulative for containers by roduct e) Install Date: <br /> Total Capacity this Pager gallons Total Capacity for Site: gallons <br /> Comments: L J /,\e Lit a r",J 0^ <br /> 09 <br /> EHD Ins r: Reviewed D t : Entered Date: <br /> /4 1)D By Initial: �0 By Initial: <br /> EHD 28-01 \ t/ <br /> 01/16/08 <br />