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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 Name: �rgoic Allelfe- Tv Page 2- of txc c . Facility Address: Stob Iry —14WLAl City: -� i Inspection Date: FA #: 100 PR #: Program Element: 2 '32- Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum z 1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. ❑ Tank (2820) P1 Containers (2821) #of Containers: 3 TAM 1 (>250 gallons) (>55 gallons and <250 gallons) Product Type: O i U Total Capacity: JAS x3 gallons or cumulative for containers by product type) Install Date: ❑ Tank (2820) N Containers (2821) #of Containers: TA#:Q'7 / 2 (>250 gallons) Total Capacity: (>55 gallons and <250 gallons) �- t Product Type: 011 S /} 111) E j x gallons (wor cumulative for containers by product type) Install Date: ❑ Tank (2820) Id Containers (2821) #of Containers: 2- TA#: (fib /±T `1'A 3 (>250 gallons) (>55 gallons and <250 gallons) Product Type: O.1 I/1) - -30 Total Capacity: SS x t2- gallons k or cumulative for containers by product type) Install Date: ❑ Tank (2820) 19 Containers (282 1) #of Containers: 2- TA#: 4 (>250 gallons) (>55 gallons and <250 gallons) Product Type: O i ( 141) 32 Total Capacity: SS x a- gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) 13 Containers (282 1) #of Containers: TAM S f- 5Q 7 5 (>250 gallons) (>55 gallons and <250 gallons) Product Type: o 1 —75W " ":-TO Capacity: s� gallons Install Date: (per tank or cumulative for containers by product type) Total Capacity this Page: gallons Total Capacity for Site: -76S" gallons Comments: EHD Inspector: Reviewed Date: TEntered Date: ( By Initial: By Initial: 11 I EHD 28-01 01/16/08