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SAN JOAQUIN COUNTY <br />:NVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <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 />Pilot Flying J #617 <br />Page 1 _ of —I <br />— <br />Facility Address: City: <br />Inspection Date: <br />15237 N. Thornton Rd. Lodi, CA 95242 Lodi <br />8-16-11 <br />FA #: <br />PR #: <br />Program Element: <br />12979 <br />Tank/Container Information <br />Complete for all sites with cumulative aboveground storage of petroleum 2!t gallons in tanks* and containers**. <br />Complete one box for each tank or each cumulative container product type. <br />0 Tank (2820) ❑ Containers (2821) #of Containers: TA#: 06o7t��3 (p <br />1 <br />Total Capacity: 20,000 gallons Product Type: diesel <br />(per tank or cumulative for containers by product type) Install Date: <br />R1 Tank (2820) ❑ Containers (2821) #of Containers: TAM �9�5o2D3� 6 <br />2 <br />Product Type: diesel <br />Total Capacity: 20,000 gallons <br />(per tank or cumulative for containers by product type) Install Date: <br />Q Tank (2820) ❑ Containers (2821) #of Containers: TA#: C�'5ae93�e2 <br />3 <br />Product Type: diesel <br />Total Capacity: 20,000 gallons <br />(per tank or cumulative for containers by product type) Install Date: l l ,� I <br />❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: <br />4 <br />Total Capacity: gallons Product Type: <br />(per tank or cumulative for containers by product type) Install Date: <br />❑ Tank (2820) ❑ Containers (2821) #of Containers: TAM <br />5 <br />Total Capacity: gallons Product Type: <br />(per tank or cumulative for containers by product type) Install Date: <br />Total Capacity this Page: 60,000 gallons <br />Total Capacity for Site: 60,000 gallons <br />Comments: While on site to perform the UST SR inspection. Technician informed me that three 20,000 gallon AST's were <br />operational as of 8-13-11. <br />EHD Inspector: Aris Cacapit <br />Reviewed <br />By Initial: <br />Date- <br />- <br />Entered Date: <br />By Initial: I <br />*Aboveground 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 <br />09/12/08 <br />