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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <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 />Change Oil Now! <br />Page 1 of 2 <br />Facility Address: <br />City: <br />Inspection Date: <br />720 E Hammer Lane G2 <br />Stockton <br />Jun 27, 2013 <br />FA #: <br />Program Element: <br />9861 <br />7.),01-53 <br />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 type. <br />#of Containers: TA#: 0517501 <br />❑X Tank (2820) ❑Containers (2821) <br />1Total <br />Product Type: used oil <br />500 <br />Capacity: 1, gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />X ❑ Tank 2820 #of Containers: TA#. 0517502 Tank(2820) ❑Containers (2821) <br />2500 <br />Product Type: 1 OW30 motor oil <br />Total Capacity: gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />X Tank ( 2820 #of Containers: TA#. 0517508 <br />) ❑Containers (2821) <br />3 <br />185 Product Type: 5W30 motor oil <br />Total Capacity: gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />#of Containers: TA#: 0517509 <br />X❑ Tank (2820) F-1 Containers (2821) <br />4 <br />185 Product Type: 5W20 motor oil <br />Total Capacity: gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />X Tank 2820) ❑Containers (2821) #of Containers: TA#: 0517511 V <br />❑ ( <br />5 <br />Product Type: ATF <br />220 <br />Total Capacity: gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />Total Capacity this Page: 2,590 gallons <br />Total Capacity for Site: 2,975 gallons <br />Comments: <br />USTs became ASTs 1-1-13 due to assembly bill -1566 <br />E In ector: <br />i, <br />Reviewed Date: <br />By Initial:. -7 <br />Entered Date: <br />By Initial: <br />j <br />bovegroun 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 04/19/12 AST SURVEY FORM <br />