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: Page -i— of Facility Address: City: in spe tion Date: l " i� FA#: PR#: Program Element: ae-:�50 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. E�/j'Tank (2820) ❑ Containers (2821) #of Containers: TA�#: " 1 Product Type: -4 L:LCiX Total Capacity: �Q 0 gallons (per tank or cumulative for containers by product type) Install Date: – — Tank (2820) Containers (2821) #of Containers: TA#:- 2 Product Type: Total Capacity: 2D O O gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Product Type: Total Capacity: l 0 0 gallons (per tank or cumulative for containers by product type) Install Date: x Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4Product Type: Total Capacity: p2 �� gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) XContainers (2821) #of Containers: _� /TA#: 5 Total Capacity: 0 5� gallons Product Type: e �1 (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: —7 L gallons Total Capacity for Site: gallons Comments: EHD Inspector: _ Reviewed Date: Entered Date: By Initial: By Initial: *AboWe nd storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. **Conr means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08