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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: T RN 000fl N6N 6A 1, Page / of�_ Facility Address: z Y`7 City: Inspection Date 2 /� A/� /' i r% r 0 C FA#: PR#: Program le ent: I ®6-;z '? -219710 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) ❑ Containers (2821) #of Containers: TA#: 5�5) S 7 1 Product Type: f. S Y f Total Capacity: gallons —Z (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: ;R 2 O Product Type: Total Capacity: /U 9Q gallons (per tank or cumulative for containers by product type) Install Date: E3-/Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3Product Type: Total Capacity: 3 �� gallons (per tank or cumulative for containers by product type) Install Date: #of Containers: TA#: e,5—t g Tank (2820) El Containers (2821) c3?, 4 � Product Type: Gt//S� .S Total Capacity: 3 � gallons (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: �� c>0 gallons Total Capacity for Site: / '2.0-0 gallons Comments: EHD Inspector: ,p 7Byinitial: eviewed Date: Entered Date: Com — �j�1G1� By Initial: 1 � *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. "Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08