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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br />Aboveground storage tanK means a tank that has the capacity to store 55 gallons or more of petroleum. <br />**Container means a storage device designed to be moved when full. <br />EHD 28-01 <br />09/12/08 AST SURVEY FORM <br />'NSG <br />Page of <br />Facility Address: <br />5 IL) <br />City: <br />Inspection Date: <br />co <br />FA #: <br />PR #: <br />— <br />Program Element- <br />Tank/Container <br />Information <br />Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks* and containers". <br />Complete one box for each tank or each cumulative container product type. <br />Lfi1/ Tank (2820) ❑ Containers (2821) <br />#of Containers: TA#: �J <br />1 <br />Total Capacity; � gallons <br />� � <br />Product Type: -O p <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />Tank (2820) ❑ Containers (2821) <br />"of Containers: TA#: Qs1,119 <br />2W <br />Total Capacity: � �() gallons <br />Product Type: � Q( <br />Ai44 u�� <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />❑ Tank (2820) [containers (2821) <br />#of Containers: TA#: PA_/ q// V ' <br />3 <br />Total Capacity: � gallons <br />5 <br />Product Type: <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />ElTank (2820) �9 Containers (2821) <br />#of Containers: I TA#: <br />4 <br />Product ,4'C <br />Total Capacity: 5� gallons <br />Type: <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />eQ Tank (2820) 11Containers (2821) <br />"of Containers: TA#: _ <br />5 <br />Total Capacity: __22�0 gallons <br />Product Type: 01 <br />(per tank or cumulative for containers by product type) <br />Install Date: <br />Total Capacity this Page: gallons <br />Total Capacity for Site: �(� `c+ ��(} gallons <br />Comments: <br />EHD Inspector: ^ <br />j <br />Reviewed <br />By Initial: <br />Date: <br />Entered Dae <br />By Initial: <br />*A�..---- <br />Aboveground storage tanK means a tank that has the capacity to store 55 gallons or more of petroleum. <br />**Container means a storage device designed to be moved when full. <br />EHD 28-01 <br />09/12/08 AST SURVEY FORM <br />