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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: Clilstop Page 2 of 3 Facility Address: City: Inspection Date: 301 W. Kettleman Lane Lodi, CA 95240 Lodi Nov 21, 2013 FA#: PR#: Program Element: FA0021137 — - 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)'1 ❑ Containers (2821) #of Containers: TA#: 1 85 Product Type: 5W-30 J Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: unknown X❑ Tank (2820 ❑ Containers (2821) #of Containers: TA#: �I S 2 85 J Product Type: 5W-30 Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: unknown ❑X Tank (2820)/ ❑ Containers (2821) #of Containers: TA#: Total Capacity: 3 851 gallons Product Type: 5W-20') (per tank or cumulative for containers by product type) Install Date: unknown f #of Containers: TA#: _� Z Tank (2820) El (2821) 4 Product Type: 10W-30 Jur Ta" Total Capacity: ons (per tank or cumulative for containers by product type) Install Date: unknown ❑X Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 240 � Product Type: 10W-30 � Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: unknown Total Capacity this Page: 605 gallons Total Capacity for Site: 2,640 gallons Comments: EHD Inspector: Reviewed Date: Entered Date: By Initial: U� ,, l� By Initial: *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more f pe roleum. **Container means a storage device designed to be moved when full. EHD 28-01 REV 04/19/12 AST SURVEY FORM