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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 EHD 28-01 01/16/08 �- Facility Name:FKA NIL AlWe—J1 If"., Pae � of 3 g Facility Address: w II L� City: Inspection Date: FA #: 1061g PR #: ^� Program Element X832 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum >_ 1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. ❑ Tank (2820) 1� Containers (2821) #of Containers: TA#: 1 (>250 gallons) . (>55 gallons and <250 gallons) Product Type: 6Ajr0lic of Total Capacity: J5 >< 2 gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) Id Containers (2821) #of Containers: �— TA#:fTj 2 (>250 gallons) (>55 gallons and <250 gallons) �Sx )-- Product Type: "�YQNSMiSSion► -�'�ul'd Total Capacity: gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) ® Containers (282 1) #of Containers: TA#:7 T 3 (>250 gallons) (>55 gallons and <250 gallons) Gl I d Product Type: M.c�i-a✓ oil Total Capacity: �. gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) 1� Containers (282 1) #of Containers: I TA#: 4 (>250 gallons) (>55 gallons and <250 gallons) Product Type: 40 Total Capacity: 9S x I gallons Install Date: (per tank or cumulative for containers by product type) ❑ Tank (2820) �] Containers (2821) #of Containers: 2 TA#: 5 (>250 gallons) (>55 gallons and <250 gallons) 2- �1 Product Type: 1 Uel�Me,6t Total Capacity: JrS x gallons Install Date: (per tank or cumulative for containers by product type) Total Capacity this Page: "T 4b gallons Total Capacity for Site: 6 �� gallons Comments: EHD Inspector: An 0j Reviewed By Initial: Date: Entered Date: By Initial: I EHD 28-01 01/16/08