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SAN JOAQUIN COUNTY <br /> " ENVIRONMENTAL HEALTH DEPARTMEI <br /> > <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 Na <br /> - 0 ' / ,��z� Page 7r of Y <br /> Facility Address: J City: ff?lA1412.. Inspe II)ste��7 <br /> r l); L, 0` Ut O( <br /> FA#: PR#: <br /> ProvM71: <br /> 0 t <br /> 7 � <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#: tjo:z-1710 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: �`'�� �/h/�� A/ 611 <br /> Total Capacity: is�s gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) Containers (282 1) #of Containers: j TA#: / <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 r Product Type: �-2 p�!�',f't-�' C/� <br /> Total Capacity: D J 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 /> 3 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 /> 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 /> 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity "his Page gallons Total Capacity for Site: gallons <br /> Comments: - <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> By Initial: By Initial: G) <br /> EHD 28-01 <br /> 01/16/08 <br />