BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY OENVIRONMENTAL 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: � N O/L C RL �(' �'� nr�- �¢ �� e� � r� Page —L of Facility Address: City: Inspe tion ate: 3'13 a to v N (o S �IGJ�1 1 7 �o FA#: PR#: Lt L4 3� fn ( I �� Prog am Element: 8 VJa 2L 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: Z TA#: 1 Total Capacity: 110 gallons Product Type: hJ if or L 16 - V6 IA/ (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) XContainers (2821) #of Containers: TA#: 2 Product Type: b 1 QST PUelt q X),0 Total Capacity: 5 S gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: Product Type: p y: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: gallons Total Capacity for Site: gallons Comments: 1 ZUUv KD N EHD Ins ector: TReviewed Date: Entered Date: By Initial: `. ,110 By Initial: 'Abovegrou d 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 09/12/08 AST SURVEY FORM