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A 1 <br /> SAN JOAQUIN COUNTY <br /> NVIRONMENTAL HEALTH DEPARTMENT <br /> -A 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 /> G Page of "L <br /> Facility Address: City: Inspecti Da e: <br /> FA#: PR#: Progr m Element: <br /> o5�81;71 <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) ontainers (2821) #of Containers: TA#: D�n LQg23A <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Product Type: p 7' <br /> Total Capacity: ri gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ontainers (282 1) #of Containers: TA#: e5J 457133 <br /> (>250 gallons) (>55 gallons and<250 gallons) , <br /> 2 Product Type: �j , (� <br /> Total Capacity: S`� gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Q Tank(2820) N-Containers (2821) #of Containers: TAM 1(951(Q <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3Product Type: <br /> Total Capacity: ,J` gallons <br /> (per tank or cumulative for contaiMrs by product type) Install Date: <br /> ❑ Tank(2820) Containers (2821) #of Containers: [ TA#: [LP q'3 6 <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 Product Type: 6 / u <br /> Total Capacity: / LO gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br /> (>250 gallons) (>55 gallons and<250 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 /> EHD Inspector: / Reviewed Date: Entered Date: <br /> By Initial: By Initial: <br /> EHD 28-01 <br /> 01/16/08 <br />