BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ,NVIRONMENTAL HEALTH DEPARTMENT o00 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:/ X 7-'-5- a ) ] G 9 t(,f Page Z- of Facility Address: City: Inspe ti n Datg: 331 ° � . n'j �/�l�R /a (l� yl 1U FA#: PR#: Program Element: 7 -2-23Z 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. ❑ Tank (2820) containers (2821) #of Containers: Z TA#: /7, 494 (>250 gallons) (>55 gallons and<250 gallons) 1 Product Type: L-t/'4 S rr,— 0" 4 , Total Capacity: L l 0 gallons (per tank or cumulative for containers by product type) Install Date: 2'-'Tank (2820) ❑ Containers (2821) #of Containers: TA#: ?0 (>250 gallons) (>55 gallons and<250 gallons) 2 Product Type: /22 p Total Capacity: Z r d gallons (per tank or cumulative for containers by product type) Install Date: ." R Tank(2820) ❑ Containers (2821) #of Containers: TA#: 3D$ (>250 gallons) (>55 gallons and<250 gallons) 3 Product Type: /'� IJ�D 2� Total Capacity: '- r6 gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: (>250 gallons) (>55 gallons and<250 gallons) 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: �j gallons Total Capacity for Site: gallons Comments: EHD Inspector: Reviewed Date: Entered Date: By Initial: By Initial: `7 EHD 28-01 01/16/08