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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 SURVEYF M Facility Name: F/�J141097-HU rG r✓T� C1 '1 f P e of Facility Address: City: Inspectio Date: FA#: PR M Progra Elerq nt: � vS' Z NSr2 -3 31 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. Tank (2820) ❑ Containers (2821) #of Containers: TA#: Z96-12153(e 2153(e � P � L 1 e: Z S l Total Capacity: p gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: _ q 2 Product Type: O J L-- Total Capacity: U0 gallons (per tank or cumulative fo containers by product type) Install Date: ET Tank (2820) ElContainers (2821) *of Containers: TA#: 3 Total Capacity: �' / S/ gallons Product Type: ill'17 o 1:0o'- 0 (per tank or cumulative for containers by product type) Install Date: tank (2820) ❑ Containers (2821) #of Containers: TA#: 4Product Type: an d��/y O l Total Capacity: �Zi7 S gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) 0 Containers (2821) #of Containers: TA#: O J 67��3 5 Product Type: /,i,7pr Td� ae V Total Capacity: f � � gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: J gallons Total Capacity for Site: Z gallons Comments: Tit39 EHD Inspector: Reviewed Date: Entered Date: By Initial: ll,-1o_p By Initial: /I/j 42- *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