Laserfiche WebLink
SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br />ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br />Facility Name: <br />P /_Page <br />� of <br />Facility Address: City: <br />C Sal S• //r,N�� qu <br />Inspection ate: <br />�Alf <br />s , <br />FA #: s-- <br />PR #: <br />Program Element: <br />Tank/Container Information <br />Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks* and containers**. <br />Complete one box for each tank or each cumulative container product type. <br />0"Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br />1Product <br />Total Capacity: � c� © gallons Type: <br />(per tank or cumulative for containers by product type) Install Date: <br />�fank (2820) El Containers (2821) #of Containers: TA#:�/ g� DO <br />2,� <br />Total Capacity: G Z -2 -gallons Product Type: <br />(per tank or cumulative for containers by product type) Install Date: <br />i <br />Q ank (2820) ElContainers (2821) #of Containers: TA#: <br />3Product <br />Type:� <br />Total Capacity: Z � �� gallons �2 <br />(per tank or cumulative for containers by product type) Install Date: <br />LYTank (2820) ❑ Containers (2821) #of Containers: T Z <br />4 <br />Product Type: <br />Total Capacity: .30 D gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />#of Containers: TA#: <br />❑ Tank (2820) ZContainers (2821) e�9�1 <br />5 <br />� Product Type: 112 6�Glf� o <br />IJ L <br />Total Capacity: gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />Total Capacity this Page: at® gallons <br />Total Capacity for Site: gallons <br />Comments: <br />EHD Inspector: _7Reviewed <br />Date: <br />By Initial: 11g1j 5_lGl_ <br />Entered Date: <br />By Initial --/ <br />*Aboveground storage tank means a tank that has the capacity to"store 55 gallons or more of petroleum. <br />**Container means a storage device designed to be moved when full. <br />EHD 28-01 AST SURVEY FORM <br />09/12/08 <br />