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SAN JOAQUIN COUNTY <br /> = <br /> " ENVIRONMENTAL.HEALTH DEPARTMENT <br /> 4 <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: Page --L—Of <br /> Facility Address: City: Inspec <br /> � 1 2 �i✓1-_ 6.. l p <br /> FA#: PR#: Progra I <br /> 6 � ,3 �` T <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks*and containers". <br /> Complete one box for each tank or each cumulative container product type. <br /> Tank (2820) ElContainers (2821) #of Containers: TA#: <br /> 1 Total Capacity: gallons Product Type: � �� <br /> (per tank or cumulative for c ntainers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 2 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ElTank (2820) ElContainers (2821) #of Containers: TA#: <br /> 3 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 4 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> 5 Total Capacity: gallons Product Type: <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: gallons <br /> Comments: <br /> i <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> r By Initial: 0"l) By Initial: 44 <br /> `Aboveground sto a tank Bans a tank that has the capacity to store 55 gallons or more of pe roleum. <br /> `*Container means a storage device designed to be moved when full. <br /> EHD 28-01 AST SURVEY FORM <br /> 09112/08 ` <br />