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SAN .JOAQUIN COUNTY -NVIRONMENTAL 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 2 of 2 Facility Address: City: Inspection Date: 2851 W. Harney Ln. Lodi, CA 95242 Lodi Feb 14, 2011 FA #: PR #: Program Element: 9351 g — 2831 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 2_1,320 gallons in tanks* and containers". Complete one box for each tank or each cumulative container product type. ❑ Tank (2820) 0 Containers (2821) #of Containers: 1 TA#: 6:V,�9 �f 1 55 Product Type: waste fuel Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 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: 55 gallons Total Capacity for Site: 2,070 gallons Comments: EHD Inspector: - Reviewed 11 Date: By Initial: VtV `� • l�{ !, I Entered Date: By Initial: j *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