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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 2of 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#: TA0516756 1Total Capacity: 1, gallons 000 Product Type: used oil (per tank or cumulative for containers by product type) Install Date: unknown ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: X❑ Tank (2820) F-1Containers (2821) #of Containers: TA#. TA0516758 3 85 Product Type: motor oil 5W20 #2 Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: unknown X❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#. TA0516759 4 120 Product Type: high mile 5W30 Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: unknown X❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: TA0516760 5 110 Product Type: gear oil 80W90 Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: unknown Total Capacity this Page: 1,315 gallons Total Capacity for Site: 4,290 gallons Comments: A EHD Inspector: i 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