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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 3of 3 Facility Address: City: Inspection Date: 4715 N West Lane Stockton Jun 6, 2013 FA#: PR#: Program Element: FA0010067 g 4? 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) El Containers (2821) #of Containers: TA#: TA0517588 1 Total Capacity: gallons llons Product Type: motor oil (5W-30) (pertank or cumulative forcontainers by producttype) Install Date: ❑X Tank(2820) El Containers (2821) #of Containers: TA#: TA0517589 21,000 Product Type: motor oil (5W-30) Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑X Tank(2820) ❑ Containers (2821) #of Containers: TA#: ea)q;re'l 3Product Type: motor oil Total Capacity: 1,000 gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: q 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: 2,500 gallons Total Capacity for Site: gallons Comments: EHD In Reviewed Date: Entered Date: By Initial: 4- 617/ 13 By Initial: Vk b eground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. "i7ontainer means a storage device designed to be moved when full. EHD 28-01 REV 04/19/12 AST SURVEY FORM