BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: , Page of Facility Address: City: Inspectin FA #: i © PR #: Program EI me . 7 /'7 �,. Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 2-1,320 gallons in tanks` and containers". Complete one box for each tank or each cumulative container product type. / Q Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Total Capacity: ,rj 9 gallons �cor Product Type: _-�2& 6Z�2_L (per tank or cumulative for miners by product type) Install Date: /Tank(2820) ElContainers (2821) #of Containers: TA#:2Total Capacity: _ / 00 G gallons Product Type: Moa _a (per tank or cumulative for containers by product type) Install Date: V/ank (2820) ❑ Containers (2821) #of Containers: TA#: _ 3 ''�l Total Capacity: �C�y gallons Product Type: S (per tank or cumulative for containers by product type) Install Date: /Tank(2820) El Containers (2821) #of Containers: TA 'n—) Q 4 4Product Total Capacity: r'-0 gallons Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 1 ; gallons Total Capacity for Site: gallons Comments: EHD Inspector:Reviewed —� By Initial: Date: �� Entered Date: By Initial: aboveground storage t:anK means a tank that has the capacity to store 55 gallons or more of petroleum. "Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08/08