BILLING - 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 Name: r C h l /Z EA91115 Page 4— of Facility Address: City: ion D e: Insp712,,C) 1;125 FA #: PR M 053034 Program EI ent: " -fin z Tank/Container Inf rmation 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. D/I Tank (2820) ❑ Containers (2821) #of Containers: #: �S/ $ 2?Z 1Product T Total Capacity: J �' 0 gallons Type: (per tank or cumulative for containers by product type) Install Date: ,�Wank (2820) ❑ Containers (2821) #of Containers: � T O,5 13 7 QV 2 Product Type: Total Capacity: <P`i/ gallons yp (per tank or cumulative for containers by product type) Install Date: #of Containers: TA#:!T- -/rank P, (2820) ❑ Containers (2821) 3 Total Capacit: gallons Product Type: (per tank or cumulative .or containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA##: dV�l iS 4 Product Type: Total Capacity: gallons / (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: �d gallons Total Capacity for Site: �/ X0 gallons Comments: EHD Inspector: Reviewed Date: By Initial: V\/I\)'� . a >� Entered Date: By Initial: pv *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. **Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08