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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMEI 600 East Main Street, Stockton, CA 95202-30,y Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.orglehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: V 1 TP C_0A % Ci i lDnl 6e-' Page of Facility Address: o s of S• ity: Inspect' n te- s o d FA #: C)G0 PR #: Program lement: Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum z 1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. Tank (2 820) ❑ Containers (2821) #of Containers: TA#: I (>250 gallons) (>55 gallons and <250 gallons) Product Type: Total Capacity: 2, O D 0 D gallons LA'J' W'— (per rk or ) ❑ Containers (2821) #of Containers: TA#: f (Q) g 2 (>250 gallons) (>55 gallons and <250 gallons) Product Type: Total Capacity: ?Zt'5 a D t) gallons Install Date: ^ (per tank or cumulative for containers by product type) Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 (>250 gallons) (>55 gallons and <250 gallons) Product Type: 0ToJ2- D! Total Capacity: gallons /j, s j zz�'h co ` ank or cumulative for containers by product type) Install Date: Er/Tank (2820) ❑ Containers (2821) #of Containers: TAM /00 4 (>250 gallons) (>55 gallons and <250 gallons) Product Type:- cn' � l�Lra'i i L 0-) Total Capacity: � G-�� U gallons y Inst l Date: kc-ra,h eo L6 ��" ` (per tank or cumulative for containers by product type) IP/Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 (>250 gallons) (>55 gallons and <250 gallons) Product Type: --may -�— U� ! j —t 1) Total Capacity: (g gallons Install Date: _� .� (per tank or cumulative for containers by product type) Total Capacity this Page: Ll- Z 4S— gallons Total Capacity for Site: gallons Co nts: i EHD Inspector: _ Reviewed By Initial: �� Dakel I Date: �iitial: L -fit - 16-v L tb EHD 2 /16/08 to-s-ko WW4