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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMEN. ' 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: l: N-r ` S O L S k V O F, Page � of Facility Address: City: Inspection D e: a M v.� k T9�l f � FA#: PR#: Program Element: o 1 D50 S �_ 'g 3 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum >1320 gallons in tanks and containers over 55 gallons. Complete one box for each tank or each cumulative container product type. CD-'fank(2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: Total Capacity: / 000 gallons / (per tank or cumulative for containers by product type) Install Date: CYTank(2820) ❑ Containers (2821) #of Containers: ► TA#: (>250 gallons) (>55 gallons and Q50 gallons) 2 Product Type: 22zlj& Total Capacity: ,r o O gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) M Containers (2821) #of Containers: TAM (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: 1!11 p rO/y D l Total Capacity: '�5 gallons (per tank or cumulative for containers by product type) Install Date: t n Irr ❑ Tank 2820 EPContainers 2821 Tank (2820) ( ) #of Containers: TAM Bim/ (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: 0 1 Total Capacity: 5 gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) 0 Containers (2821) #of Containers: I TA#: Q`u- (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: S O Total Capacity: .�_f gallons Install Date: (per tank or cumulative for containers by product type) Total Capacity this Page: gallons Total Capacity for Site: Z gallons Comments: EHD Inspector: Reviewed Date: Entered Date: . 6 By Initial: 'I _p By Initial: EHD 28-01 V 01/16/08