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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: N C PA Page 1 of I Facility Address: City: Inspection Date: 2131 W. Turner Rd. Lodi, CA 95240 Lodi Jan 21, 2011 FA #: 9893 PR #: �53� Program Element: 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. FX] Tank (2820) ❑Containers (2821) #of Containers: TA#: O� 2e!,D 742 1 120,000 Product Type: diesel Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: X❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 7 7 2Total 2,000 Product Type: diesel Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) X❑ Containers (2821) #of Containers: 1 TA#: 560 9079 3 55 Product Type: used oil Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: XJ Tank (2820) F1Containers (2821) #of Containers: TA#: 5�BD7� 4 100 Product Type: oil Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: X❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 65aD04 � 5 190 Product Type: diesel Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 122,345 gallons Total Capacity for Site: 122,345 gallons Comments: APSA survey Completed. EHD Inspector: Reviewed Date: By Initial: 1A/0 %,IA,1 0 Entered Date: By Initial: 1 *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleurrl. **Container means a storage device designed to be moved when full. EHD 28-01 REV 06/03110 AST SURVEY FORM