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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.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: Lodi Muni Service Center Page 2 o 2 Facility Acidness: City: Inspection Date: 1331 S. Ham Ln. Lodi, CA 95240 Lodi Sep 16, 2011 FA#: PR#: Program Element: 3961 2831 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 2_1,320 gallons in tanks*and containers"* Complete one box for each tank or each cumulative container product X❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: a a'qq 1 120 Product Type: Oil Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑X Tank (2820) ❑ Containers (2821) #of Containers: TA#: 9Ja2��aa 2120 Product Type: oil Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑X Tank (2820) ❑ Containers (2821) #of Containers: TA#: 95aD��3 3 120 Product Type: oil Total Capacity: gallons I N01 (per tank or cumulative for containers by product type) Install Date: ❑X Tank (2820) ❑ Containers (2821) #of Containers: 1 TA#: ha� � 4 120 Product Type: oil Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: -t ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 480 gallons Total Capacity for Site: 2 090 Ilo Comments: While on site for a routine hazardous waste inspection these above ground storage tanks were observed. EHD Inspecloc Reviewed Date: Entered Date: By Initial: I \``L' By Initial: *Aboveground 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 REV 06103/10 AST SURVEY FORM