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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 SURVEY FORM Facility Name: 2 O j G Page of 4d vLg-r Facility Address: City: Insp7T'� eA -7,-3 �- L�0 w F l r_ FA#: PR#: Program Element: 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) El Containers (2821) #of Containers: TA#: � )g 17 1 Product Type: �2,(-g,�,> Total Capacity: ,/15�O 0 c _gallons (per tank or cumulative for containers by uct type) Install Date: #of Containers: TA#: rank5.1 (2820) El Containers (2821) 2 Product Type: -� Total Capacity: �U--tr gallons (per tank or cumulative for containers by product type) Install Date: ank (2820) ❑ Containers (2821) #of Containers: TA#: S 3 Product Type: Total Capacity: gallons (per tank or cumulative for containers byproduct type) Install Date: ❑ Tank (2820) d'Containers (2821) #of Containers: TA#: 4 Total Capacity: lle�9 gallons Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: gallons Comments: EHD Inspector: Reviewed Date: Entered Date: C--- 10 By Initial: fS,�Gt. By Initial: a(� *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more 6f petroleum. **Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08