BILLING - Laserfiche WebLink

Home Browse Search

i SAN JOAQUIN COUNTY sENVIRONMENTAL 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: � 3 I 3 5 ,� Page of Facility Address: Q City: Inspec n Dle FA r PR #: ® 51,-!�o Program'Eleff q- DD l/ Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 20,320 gallons in tanks* and containers**. Complete one box for each tank or each cumulative co tainer product type. El Tank (2820) Ek/Containers (2821) #of Containers: TA#: 1 -� Product Type: ,A-Z'y D.�'Z 6��. LJ Total Capacity: 12, gallons (per tank or cumulative for containers by product type) Install Date: #of Containers: �^ TA#: _ 1 Q D 2 ' / El Tank(2820) i[� Containers (2821) 2Product Total Capacity: /' % ,) gallons Type: C/ C (per tank or cumulative for containers by product typel Install Date: Tank (2820) ❑Containers (2821) #of Containers: TA#: 3 Product Type: Total acity: b -( gallons (per tank or c ulative for containers by product type) Install Date: Tank (2820) Elpiners (2821) #of Containers: A#: 4 r Product Type: " Total Capacity:gallons (per tank or cumulative for containers by product type) nstall D Tank (2820) Elontainers (2821) # on Hers: #: _ y 5 Product Type: Total Capacity: Ballo (per tank or cumulative for containers by product type Install Date: Total Capacity this Page: S gallons Total Capacity for Site: �3' gallons \� Comments:24 ( Z 9 2 --0 v EHD Inspector: ` Reviewed Date: By Initial: VA Entered Date: By Initial TIJ *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. i **Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08