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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: Crop Production Services Page 2 of 2 Facility Address: City: Inspection Date: 1905 N. Broadway, Stockton Stockton Jun 24, 2011 FA #: PR M Program Element: FA0010413 --S1781 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. #of Containers: 6 TA#: D oZ b) ❑ Tank (2820) 0 Containers (2821) 1330 Product Type: L Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Product Type: Total Capacity: 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: 330 gallons Total Capacity for Site: 2,280 gallons Comments: EHD Inspect Reviewed Date: Entered Date: By Initial: By Initial: *Alyvegr stage tank maedis a tank that has the capacity to store 55 gallons or more of petroleum. **Contai means a storage device designed to be moved when full. EHD 28-01 REV 06/03/10 AST SURVEY FORM