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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEN' <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 /> C? �>� L l p �c lJ I A Page of <br /> Facility A dress: City: Insp'ctionlDa : <br /> k1 G s� �c C14 9.57 " S � 13 <br /> FA#: PR#: Program lement- <br /> o5 2831 <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum Z 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) ❑ Container ers: TA#: p <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 1 Total Capacity: 1 o d P gallons Product Type: �"'_��l;�i�1 S <br /> (per tank or cumulative for containers by product type) Install D G�� <br /> Tank(2820) ❑ Containers (2821) #of Containers: TA#: /7Q�j <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 2 Product Type: <br /> Total Capacity: I O D e gallons ©db 61A <br /> (per tank or cumulative or containers by product type) Install Date: <br /> f T k(2820) ❑ Containers (2821) #of Containers: TAM (�6-1';?4�2$'(p <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 3 Product Type: 19 <br /> Total Capacity: f o O gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Y <br /> Tank (2820) ❑ Containers (2821) #of Containers: TAM <br /> (>250 gallons) (>55 gallons and<250 gallons) <br /> 4 � Product Type: <br /> Total Capacity: ,00 gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> ❑ Tank(2820) Containers (2821) #of Containers: TAM d5 76_Z> <br /> (>250 gallons) (>55 gallons and<250 gallons) y 1*5 Product Type: d,{Q�{ {f7G�l It <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: 3 gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHDtor: Reviewed Date ,1.�'�9 Entered Dasa <br /> By Initial: �' `C By Initial: 7��/E <br /> ell <br /> EHD 28-01 <br /> 01/16/08 <br />