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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMr <br /> 600 East Main Street,Stockton,CA 95202-3, <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 /> S 1i T S T �?.� Page —of <br /> Facility Address: City: Inspecdo 'Dae:253 � Hwy 9 9 oB <br /> ProgramElement: <br /> 0 0 0 C).z Z9 5-1 S-1 // 2- <br /> Tank/Container Informatio"- <br /> Complete for all sites with cumulative aboveground storage of petroleum 21320 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 C r�tai ers �4# //07 7K <br /> (>250 gallons) (>55 gallons an59 gallons) W <br /> 1 `- -- --Pro uca I 1 ype: 10,- i <br /> Total Capacity: _ Z-0-a- -6j — gallons " <br /> (per tank or cumulative for containers by product type) Install D aL. <br /> lGx k-U �^ <br /> ank (2820) El Containers (28 21) V 1,� i�%IIonta" 'i A#: O�1 j� `7-7 <br /> (>250 gallons) (>55 gallons and 450 Ballo � ��� <br /> 2 Product Type: a <br /> Total Capacity:-- -,� -b,70-~ gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and 450 gallons) <br /> 3 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Dat':;: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product i yp-1 : <br /> Total Capacity: gallons Install Date: <br /> (per tank or cumulative for containers by product type) <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and 450 gallons) <br /> 5 Product Type: <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: gallons <br /> Comments: <br /> �vJs <br /> f <br /> L <br /> EHD Inspector: Reviewed Date: Entered Date: <br /> B <br /> � •,�� y Initial: vo�l �,.l,Q-Ob By Initial: D <br /> n <br /> EHD 28-01 <br /> 01/16/08 <br />