Laserfiche WebLink
or ` SAN JOAQUIN COUNTY <br /> ti <br /> lX'e <br /> ENVIRONMENTAL HEALTH DEPARTMEN I , 41 <br /> 600-Fast 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: ,/� S L�-C�C Page of l <br /> Co .A " <br /> Facility Address: City: Inspecti Date <br /> d " g �T I/VATx JA Sr . D <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 /> Uk'fank(2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55.gallons and<250 gallons) �� by <br /> 1Product Type: � (s <br /> Total Capacity: d gallons Install Date: L< r /V - <br /> (per tank or cumulative for containers by product type) — <br /> lank(2820) ❑ Containers (2821) #of Containers: ` TA#:' <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: <br /> Total Capacity: ��� gallons e�_ <br /> Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank(2820) 'I�Containers (282 1) #of Containers: TA#: <br /> G (>250 gallons) (>55 gallons and X750 gallons) <br /> 3 Product.Type:' T <br /> Total Capacity: C-1 gallons <br /> j (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) E Containers (2821) #of Containers: J - TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) � <br /> `4 Product Type: <br /> Total Capacity: gallons <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 /> i 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: Z`Zig gallons <br /> Comments: <br /> EHD Inspector: ! Reviewed Date:. Entered Date: <br /> By Initial:' ryr',�,�� By Initial: �D <br /> EHD 28-01 <br /> 01/16/08 <br />