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SAN JOAQUIN COUNTY -MIRONMENTAL 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: Simplot Grower Solutions Page 1 of 2 Facility Address: City: Inspection Date: 2851 W. Harney Ln. Lodi, CA 95242 Lodi Feb 14, 2011 FA #: PR #: Program Element: 9351 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: TA#: ❑X Tank (2820) ❑Containers (2821) 1 850 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#: d6aD(D7 2500 Product Type: 87 octane gasoline Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑X Tank (2820) ❑ Containers (2821) #of Containers: TA#: D<3 500 Product Type: used oil Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: #of Containers: 2 TA#: ❑ Tank (2820) ❑X Containers (2821) 4 110 Product Type: oil Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑X Containers (2821) #of Containers: 1 TA#:�� 5 55 Product Type: used oil Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: 2,015 gallons Total Capacity for Site: 2,070 gallons Comments: AST survey conducted while on site to perform the routine hazardous waste inspection. EHD Inspector: n Reviewed Date: By Initial:�� Entered Date: By Initial: — �� 02 *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. **Container means a storage device designed to be moved when full. EHD 28-01 REV 06/03/10 AST SURVEY FORD