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PSAN 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: 7D 7 piZ ff I )NS. Page of Facility Address: SRA M S� r City: �� Inspection ate: K 31 f a FA #:4 PR #:D��D�� Prog -xam �: 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. Eq -'tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Product Type: Total Capacity: gallons (per tank or cumulative f -containers by product type) Install Date: Kanank(2820) ElContainers (2821) #of Containers: TA#: ) L7 0 2 Total Capacity: %� gallons Product Type: (per tank or cumulative for containers by product type) Install Date: #of Containers: TA#: B�)� l yi� ❑ Tank (2820) Ly'Containers (2821) 3 Z-00Product Total Capacity: '�� gallons Type: � (per tank or cumulative for containers by product type) Install Date: El Tank (2820) C4/6ontainers (2821) #of Containers: TA#: I 4 Product Type: ✓ Total Capacity: T� gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 19 gallons Total Capacity for Site: % ? gallons Comments: ZD O EHD Inspector: 7eviewed Date: Initial: Entered Date: By Initial: "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