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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 3of 3 Facility Address: City: Inspection Date: 500 E. Kettleman Ln. Lodi Aug 7, 2014 FA M 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#: TA0516761 1 Total Capacity: gallons 85 Product Type: 1 OW30 Conventional (per tank or cumulative for containers by product type) unknown Install Date: X❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: ? 2185 Product Type: 5W30 Conventional Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: unknown X❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: ? 3 Product Type: 5W30 Blend Total Capacity: 120 gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ 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: 390 gallons Total Capacity for Site: 4,290 gallons Comments: AOel IL EHD Inspector: Reviewed Date: Entered Date: Y_ ) W 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