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JO--QUIN COUNTY <br /> J i ENVIRONMENTAL HEALTH DEPARTtMEN t <br /> 600 East Nfain Street, Stockton, CA 95202-3029 <br /> * Teleohone: (209)468-3420 Fax: (209)468-3433 Weh:www.sjgov.org/ehd <br /> BOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FOR1 <br /> FacilityN me: Save / of Z� <br /> N) ©A/ e I r � D r- V Q L C,A pb <br /> Facility Address: City: ,nspection at <br /> F PR#; r Program Element: <br /> 2 3 <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 /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: 7V e <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: half S/ <br /> Total Capacity: 2 b gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> i <br /> Tank (2820) '❑ Containers (2821) #of Containers: TA#: & <br /> w I />250 gallons) (>55 gallons and<250 gallons) <br /> 2 I `` Product Type: ���C:�� <br /> Total Capacity: J � gallop Install Date: <br /> (per tank or cumulative for containers by product type) -- <br /> P'Tank (2820) ❑ Containers (2821) #of Containers: Ty 175 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> Product Type: 17,Z - <br /> Total Capacity: 3' O� gallons 1 r + . <br /> In i,a1,. <br /> (per tank or cumulative for containers by product type) <br /> 10 <br /> � a <br /> n PrS 2 2 1 rn t <br /> L/ { <br /> Tall (2820) ❑ �onta n�_ ( 8_I, Tol �ontai�iers: <br /> / (>250 gallons) (>55 gallons and<250 gallons) <br /> v Product Type: !�� <br /> J <br /> a ra `t-apgmt�7: ga1'lnns <br /> Wie or containers by product ioipe,,(ozr tan yr cutnua ! <br /> .. --- <br /> Q i <br /> 3 21. (797n� — "1' 2`l21' frof Containers: 7j TAT: �17�1Q <br /> _50 gallons) (>5c gallons and<250 gallons) i► <br /> T uDL: <br /> 00 Al <br /> 1 --- <br /> I <br /> Reviewed Uatc: =EnteredeD Inspector. TBByRe Initial: Ct7-�-0 t <br /> EHD 28-01 <br /> 01/16/08 <br />