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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: <br /> Lodi Muni Service Center Page 1 of 2 <br /> Facility Atltlfeas: City: Inspection Date: <br /> 1331 S. Ham Ln. Lodi, CA 95240 Lodi Sep 16, 2011 <br /> FA A. PRA: Program Element: <br /> _ <br /> 3961 �Z o4 Il 2831 <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum >_1,320 gallons in tanks'and containers". <br /> Complete one box for each tank or each cumulative container product <br /> ❑ Tank ( )2820 Containers (2821) <br /> X #of Containers: TA#: [i <br /> ❑ <br /> 1 Total Capacitygallons 00 Product Type: used oil <br /> : <br /> (per tank or cumulativx for ren M product type) <br /> Install Date: <br /> ❑X Tank (2820) ❑ Containers (2821) #of Containers: TA#: fJ3?F-{ l Z <br /> 2 50 Product Type: oil <br /> Total Capacity: gallons I n <br /> (per tank or cumulative for containers by product type) <br /> Install Date: <br /> ❑X Tank (2820) [71Containers (2821) #of Containers: TA#: CSaf�.7 L <br /> 3 500 Product Type: oil <br /> Total Capacity: gallons <br /> (per tank or cumulabve for containers by product type) Install Date: <br /> ❑ Tank (2820) ❑X Containers (2821) #of Containers: 1 TA#: F!26:a,C-4 10/ <br /> 4 55 Product Type: oil <br /> Total Capacity: gallons �Q{{��,,--�� <br /> t— <br /> (pertank or cumulative for containers by product type) Install Date: ✓`fit , gy <br /> ❑ Tank (2820) X❑ Containers (2821) #of Containers: 1 TA#: 0'6' Op a r� <br /> 5 55 Product Type: <br /> solvent <br /> Total Capacity: gallons <br /> (per tank.,cumve ulatifor containers by product type) Install Date: �l <br /> Total Capacity this Page: 1,610 gallons Total Capacity for Site: 2,090 gallons <br /> Comments: <br /> While on site for a routine hazardous waste inspection these above ground storage tanks were <br /> observed. <br /> EHD Inspector Reviewed /� Date: Entered Date: <br /> By Initial: ,] ✓ By Initial: g L� <br /> 'Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. <br /> "Container means a storage device designed to be moved when full <br /> EHD 28-01 REV 06/03/10 AST SURVEY FORM <br />