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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTME1 <br /> 600 East Main Street, Stockton,CA 95202-302Y <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: ,sc Page / of <br /> !/G1z ���s. v%�/ham" g l/ <br /> Facility Address: /,� �/� City: S.T'� Inspection Da <br /> / Ul� S rir/i G �1'o Al <br /> FA#: PR#: Program lement: <br /> CC) 0 97 / Z a5 / �-; z <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 /> ank (2820) Containers (2821) #of Containers: TA#: Qs &llll <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: C7/ <br /> Total Capacity: S51 1/,9 gallons r <br /> (per tank or cumulative for containers by product type) Install Date: p <br /> a rs 2821 #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons y <br /> 2 Product T <br /> Total Capacity: _�-,j gallon <br /> (per tank or cumulative for containers by pr e Install Date: <br /> J Tank (2820) Containers (2821) #of Containers: d�— TA#: DUB I&D I � <br /> �(>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: W" <br /> Total Capacity: ?!V/19 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> TA#: D <br /> 12�5g.11cns) (>55 gallons and<250 gallons) <br /> 4 Product T e: <br /> Total Capacity: .S� gal s <br /> (per tank or cumulative for contai ers e Install Date: <br /> ank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 5 Product Type: {h/. Q 3 <br /> Total Capacity: I U(1 (2 gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> Total Capacity this Page: 2 Zo gallons Total Capacity for Site: ZZZ gallons <br /> Comments: <br /> EHD Inspector: / / Reviewed 1 � ate: Entered Date: <br /> C , f3• � / 6 By Initial: v\ "] By Initial: D <br /> EHD 28-01 v <br /> 01/16/08 <br />