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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM <br /> 600 East Main Street, Stockton,CA 95202-,,j29 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM-7/ <br /> Facility Name: 6 Page of !� <br /> ✓r' / <br /> Facility Address: City: Inspection Il-t­ <br /> FA#: PR#: rrogram Element: <br /> a � o� a � 2531 <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum >_1320 gallons in tanks and containers over 55 gallons. <br /> Complete one box for each tank or each cumulative container product type. <br /> ❑ Tank(2820) Containers (2821) #of Containers: 2 TA#: B,51 (e le <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type /Z <br /> Total Capacity: / gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ►B Containers (2821) #of Containers: TA#: ` (P LP (P02 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: 41 /- <br /> Total Capacity: gallons Install Date: <br /> per tank or cumulative for co ia' ers by product type) <br /> ank (2820) Containers (2821) #of Containers: y TA#: 195 f le(r IF3 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: /�D� //J' ,j�au� <br /> Total Capacity: 'z-, �iS' gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: 12,,5-1 LC It <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: y/2G&4,4� <br /> Total Capacity: SOD gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> M//Tank (2820) 0 Containers (2821) #of Containers: TAM (p (ps <br /> 5 Product <br /> (>250 gallons) (>55 gallons and<250 gallons) Type: � �7 <br /> Total Capacity: Shy) gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: dz gallons Total Capacity for Site: 3 7 gallons <br /> Comments: <br /> 7 YarP Ir y o f Z Z o 0 0 <br /> 44-006 oW! <br /> EHD Inspector: Reviewed ` Date: / Entered Date: <br /> By Initial: UJ ` .o By Initial: z gf <br /> EHD 28-01 <br /> 01/16/08 <br />