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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: S To le, r" Page _/ of -z- Facility Facility Aclres City: Inspection Date: �v L� JU/ / /3 m FA#: 1 n PR#: Program Element: Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks`and containers". Complete one box for each tank or each cumulative container product type. 4XTank (2820) ❑ Containers (2821) #of Containers: TA#: j26-I 2-7 1 Total Capacity: /D o p gallons Product Type: 4a_"� (per tank or cumulative for containers by product type) Install Date: Tank (2820) El Containers (2821) #of Containers: TA#: /95177±1 2 Product Type: Total Capacity: 2- G e'YO gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: Q ,rJ [774,f;_ 3 '� Product Type: �ti� T� C) Total Capacity: �� gallons (per tank or cumulative for containers by product type) Install Date: L 'Tank (2820) ❑ Containers (2821) #of Containers: TA#: — _ 4 Product Type: 61J— Total Capacity: �' S� gallons (per tank or cumulative for containers by product type) Install Date: PIT/ank (2820) ❑ Containers (2821) #of Containers: TA#: -17 147 5 Product Type: �,d44C�� L Total Capacity: 2, 00 gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: S ,? gallons Total Capacity for Site. s gallons Comments: EHD Inspector /� Reviewed Date: Entered Date: By Initial: 1��_Or/l By Initial: 1 "Aboveground storage tank 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