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.sigov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> f)C(S6r &Af ( C GI�-�� LLC Page of <br /> Facility Address: City: Ins e/etion D e: <br /> FA#: PR#: 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 /> 2/Tank (2820) <br /> / <br /> Complete one box for each tank or each cumulative container product type. <br /> Lel Tank (2820) ❑ Containers (2821) #of Containers: TA#: �0,671qqll-�3 <br /> 1Product Type:Total Capacity: -�`��% gallons 2�/' 1�e2T e'/ <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> Tank (2820) ❑ Containers (2821) #of Containers: TA#: �—L� <br /> 2Product Type: ! <br /> Total Capacity: �_gallons <br /> (per tank or cumulative for containers by product type) Install Date: <br /> #of Containers: <br /> Tank (2820) El Containers (2821) ners: TA#: <br /> 3 Total Capacity: Product Type: A'4 0 f z)y- <br /> O gallons <br /> (per tank or cumulative for containers by product type) <br /> I <br /> <br /> <br /> gallons Product Type: <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> ❑ Tank (2820) 2-containers (2821) #of Containers: Z TA#: B <br /> 5 Total Capacity: /(J `J gallons Type: <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 Inctor: Reviewed Date: jBy <br /> ered Date: <br /> By Initial: nitial: 0 <br /> *Ab gr nd storage tank a tank that has the capacity to store 55 gallons or more of petroleu . <br /> **C finer means a storage device designed to be moved when full. <br /> EHD 28-01 <br /> 09/12/08 AST SURVEY FORM <br />