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SAN JOAQUIN COUNTY 14WO `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: nA Pe (a �/h 2 S Yvi C s -V✓I C. Page J_of f Facility Address: City: Inspection Date: 40 l N _ D S-( OCIC!fZ" —V za Zo�a FA#: PR#: Program Element: 2831 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. id Tank (2820) ❑ Containers (2821) #of Containers: TAM O 1 Product Type: �k Total Capacity: '� gallons (per tank or cumulative for containers by product type) Install Date: L')H 'iL—" to-Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Total Capacity: �� gallons Product Type: 11 a 1 (per tank or cumulative for containers by product type) Install Date: un Tank (2820) ❑ Containers (2821) #of Containers: TA#: l7 3 Total Capacity: /X" /�;D gallons Product Type: 1� SQIy i (per tank or cumulative for containers by product type) Install Date: 1 ) NIC— E] 4L ❑ Tank (2820) r f Containers (2821) #of Containers: 2 3 TA#: 4 Total Capacity: / 1 0 R gallons Product Type: Hit," I it," 4S—U (per tank or cumulative for containers by product type) Install Date: L)N,y- ❑ Tank (2820) :9-Containers (2821) #of Containers: 1 TAM 5 �- Product Type: �\ gNAr / A•2ars o K $ v114S Total Capacity: �' C1 gallons —T--+ (per tank or cumulative for containers by product type) Install Date: lit Yl Total Capacity this Page: gallons Total Capacity for Site: 171 gallons Comments: u�tl2 a ' k " OOU EHD Inspector: Reviewed Date: Entered Date: By Initial: By Initial: �v A74 lD *Aboveground storagb tank meapIs 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