BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

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 Nam S/-Z)(-1k--A-v-? � 7 � � �� C� -17 Pae sof 9 Facility Address: City: / Inspe tion Date: cSY& FA M PR #: Pro §rr7amElement: 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. Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Total Capacity: O 0 gallons Product Type: (�Q 07 (per tank or cumulative for c ntainers by product type) Install Date: ❑ Tank (2820) VContainers (2821) #of Containers: TA#: 2 Total Capacity: ��y gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) kbontainers (2821) #of Containers: TA#: 3 Total Capacity: / % (� gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Total Capacity: gallons Product Type: (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: --:;2y �j� gallons Comments: EHD In ector:Reviewed Date: Entered Date: By Initial: By Initial: "Ab vegr Ad storage tank means—a tank that has the capacity to store 55 gallons or more of petroleum. ""Con ner means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08