Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: 1P , <br /> —T. Lvlvl A R D Page—/—of , <br /> Facility Address: city: Irtspection ate: <br /> FA#: PR#: Program Element: <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks*and containers**. <br /> Complete one box for each tank or each cumulative container product type. <br /> #of Containers: TA <br /> RT Tank {2820} ❑ Containers (2821) : D <br /> 1 Total Capacity: /D J. 517 <br /> r <br /> f C Product Type: .. <br /> � � gallons <br /> (per tank or cumulative for containers by product type) Install ©ate: <br /> i <br /> Tank (2820) ❑ Containers (2821) #of Containers: TAM &517M? <br /> 2Product Type: !—' <br /> Total Capacity: 10 gallons <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> ElTank (2820) L� Containers (2821) #of Containers: + TAM �J�1 `� PSI <br /> �, <br /> 3 Product Type: Olt, <br /> Total Capacity: gallons _ ---- <br /> p Y� <br /> (per tank or cumutative for containers by product type) Install Date: <br /> LK Tank (2820) El Containers (2821) #of Containers: TA#: �J-I ` Q� <br /> 4 -17Product Type: Hyfq'r 0"e <br /> Total Capacity: > e' 0 gallons Yp <br /> (per tank or cumulative for containers by product type) Install Date: <br /> I T Tank (2820) Containers (282 1) #af Containers: TAM -7q <br /> 5 Total Capacity: �� gallons Product Type: `— �/ f <br /> (per tank or cumulative for containers by product type) Install Date: <br /> Total Capacity this Page: gallons Total Capacity for Site: gallons <br /> Comments: <br /> EHD inspector: Reviewed ���f( Date: Entered Dater <br /> By Initial: I�!""' - By Initial: <br /> *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more ofp6troleum. <br /> **Container means a storage device designed to be moved when full. <br /> EMD 28-01 AST SURVEY FORM <br /> nars��nu <br />