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SAN.JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: Jiffy Lube #2322 Page 1 of 3 Facility Address: City: Inspection Date: 500 E. Kettleman Ln. Lodi Aug 7, 2014 FA#: PR#: Program Element: FA0010973 2831 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum ?1,320 gallons in tanks"and containers". Complete one box for each tank or each cumulative container product type. X❑ Tank (2820) F1 Containers (2821) #of Containers: TA#: TA0516752 1 Total Capacity: 1, gall 000 Product Type: motor oil 5W30 ons (per tank or cumulative for containers by product type) Install Date: unknown X❑ Tank (2820) F-1Containers (2821) #of Containers: TA#. TA0516753 2 Total Capacity: 1, gall 000 Product Type: motor oil 5W20 ons (per tank or cumulative for containers by product type) Install Date: unknown ❑X Tank (2820) ❑ Containers (2821) #of Containers: TA#: TA0516754 3 250 Product Type: motor oil 15W40 Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: unknown ❑X Tank (2820) F1 Containers (2821) #of Containers: TA#: TA0516757 4 250 Product Type: ATF Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: unknown ❑X Tank (2820) F] Containers (2821) #of Containers: TA#: TA0516755 585 Product Type: motor oil 5W30 Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: unknown Total Capacity this Page: 2,585 gallons Total Capacity for Site: 4,290 gallons Comments: EHD Inspector: Reviewed Date: Entered Date: By Initial: 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 04/19/12 AST SURVEY FORM