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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 #2497 Page 1 of 3 Facility Address: City: Inspection Data: 4715 N West Lane Stockton Jun 6, 2013 FA#: PR#: Program Element: FA0010067 49-" 2831 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks*and containers**. Complete one box for each tank or each cumulative container product type. ❑X Tank (2820) Ll Containers (2821) #of Containers: TA#: TA0516465 1 Total Capacity: gallons llons Product Type: used oil (per tank or cumulative for containers by product type) Install Date: ❑X Tank (2820) El Containers (2821) #of Containers: TA#: TA0516467 2120 Product Type: motor oil 1 OW-30 Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Tank (2820) r-1 Containers (2821) #of Containers: TA#: TA0516468 3 120 Product Type: gear oil 8OW-90 Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑X Tank(2820) E] Containers (2821) #of Containers: TAM TA0516469 4 85 Product Type: motor oil 15W-40 Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑X Tank(2820) El Containers (2821) #of Containers: TA#: TA0516470 5 120 Product Type: ATF Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 1,445 gallons Total Capacity for Site: C3 7 gallons Comments: -ey i6 )� -T/� �rd^-t P2 0S' act I � evj pC 28"3 EHD Inspector. ReviewedDate: '] Entered Date: By Initial: J�i 6D/0 By Initial: 7 15 3 0 ound stord§nank means a tank that has the capacity to store 55 gallons or more of petroleum. ntainer means a storage device designed to be moved when full. EHD28-01 REV04119/12 AST SURVEY FORM