BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY r r� 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: O S PAIS 3 � 3 Page of� Facility Address: City: Ins p c on Date: Z S. A/ p FA#: PR M Pr6rgr4rn EI nt: �2L D Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum ?1,320 gallons in tanks*and containers`*. Complete one box for each tank or each cumulative container product type. EY/Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 1 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Hank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) M Containers (2821) #of Containers: �_ TA#: 3 Product Type: -iS 'J Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Product Type: Total Capacity: gallons (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: gallons Total Capacity for Site: gallons Comments: EHD Inspector: Reviewed Date: Entered Date: By Initial: VA 'p ►�0• By Initial: 7/1 *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. 074] **Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08