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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.sigov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: �/ Z-egg 7 Platt Page of 45 Facility Address: City: Inspectio Date: 020/f2 N- "Qe mar 8��. 9 ��/io FA#: PR#: Program Element: x802 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#: 1'u514?L?)99 1 Total Capacity: Product Type: _/�7(y Eh�r POjyO,� ?�� gallons (per tank or cumulative for containers by product type) —�/�✓— / Install Date: )( Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Product Type: P01 U ro4-1�W Total Capacity: gallons Ij (per tank or cumulative for containers by product type) Install Date: a aDoq-- 'I�<Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1 3 Product Type: /�O/q -f k g' } �O/U D Total Capacity: aqZ gallons (per tank or cumulative for containers by product type) Install Date: X Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 l r� P;�� ��L/D Total Capacity: (PJProduct Type: PO � gallons -----v (per tank or cumulative for containers by product type) Install Date:N�ta afl Tank (2820) ❑ Containers (2821) #of Containers: TA#: / 5 Total Capacity: Product Type: /�O�U�??PD/e.JO�_ p y: gallons (per tank or cumulative fo containers by product type) Install Date: -;2-49' O Total Capacity this Page: /q 9?441 gallons TTotal Capacity for Site: -74p, S�3 gallons Comments: LEHDInspect Reviewed I Date: Entered Date: By Initial: `v,�,w� l� Q By Initial: i �7/ v "Above ou 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