BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

u SAN JOAQUIN COUN'T'Y VIRONMENTAL HEALTH DEPARTMEN' � East Main Street,Stockton,CA 95202-302 ' N Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.orglehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: / Page of 1;7,4+1 i,C c X 6, AD City: Inspection Drtt - /y��J Facility Address: /C� 3 r/a /y( IAIAWONR S fi Program Element: FA#: Tank/Container Information. j Complete for all sites with cumulative aboveground storage of petroleum 2-1320 gallons in tanks and''cotttainers over 55 gallons. Complete one box for each tank or each cumulative container product type. Tank (2820) ❑ Containers (2821) #of C rs:. A : (>250 gallons) (>55 gallons and X250 gallons) � 1 roduct Type: Total Capacity: gallons tall Date: (per tank or cumulative for containers by product type) i ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and Q50 gallons) 2 Product,Type: Total Capacity: gallons Install Datc: (per tank or cumulative for containers by product type) ❑ Tank(2820) ❑ Containers (2821) #of Containers: TA#: 'F (>250 gallons) (>55 gallons and X250 gallons) � 3 Product!Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: 1 ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: Total Capacity: gallons (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 Produeti Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons 1Total Capacity for Site: gallons �l Comments: 4 P; z,o '9 �1�6 EHD Inspector: Reviewed i Date: Entered Date: By Initial: t w�.1 (��.0A By Initial: EHD 28-01 01/16/08 lk `k - t -