Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM' <br /> 600 East Main Street, Stockton,CA 95202-- .:9 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: b <br /> Page L—of—� <br /> Facility Address: City: Inspecti n Date <br /> o - W/,l/ Lrry 4 121 <br /> FA#: 9 R#: Program E t: <br /> vc�o 1 � <br /> Tank/Container Information 2 5 3 <br /> Complete for all sites with cumulative aboveground storage of petroleum >_1320 gallons in tanks and containers o <br /> _ L Complete one box for each tank or each cumulative container product type. <br /> LI�''1'ank(2820) ❑ Containers (2821) #of Containers: TA#: z9,51 T$,�2�e <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: 6:--19S <br /> Total Capacity: •Sd 4 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: Q <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: &k6 b <br /> Total Capacity: 00 6 gallons <br /> (per tank or cumulative for dontainers 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: ReQ e, <br /> Total Capacity: Ll 0 V 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 this Page: oU gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHD Inspector. Reviewed Date: Entered Date: <br /> By Initial: 1^� (�,�,G� D� By Initial: -y <br /> EHD 28-01 v t <br /> 01/16/08 <br />