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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209) 468-3433 Web:www.sjgov.org/ehd <br /> ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM <br /> Facility Name: <br /> Tracy Ford Page 2 of 2 <br /> Facility Address: City: Inspection Date: <br /> 3500 Auto Plaza Way Tracy Jun 13, 2011 <br /> FA#: PR#: Program Element: <br /> 0010988 10528233 2831 <br /> Tank/Container Information <br /> Complete for all sites with cumulative aboveground storage of petroleum >_1,320 gallons in tanks'and containers`*. <br /> Complete one box for each tank or each cumulativ con product type. <br /> ❑ Tank (2820) X❑ Containers (2821 TA#: 2 <br /> 1 Total Capacity: gallons 120 Product Type: 15W-40 <br /> (per tank or cumulative for containers by product type) Install Date: Service Dept(portab <br /> 20) X❑ Containers (2821) #of Containers TA#: 4 5e?f, <br /> 2Total Capacity: gallons <br /> 120 Product Type: 5W-20 <br /> (per tank or cumulative for containers by pr Date: Service Dept(portable) <br /> ❑ Tank (2820) 0 Containers (2821) #of Containers TA#: 11)3j,,6__ <br /> 3 Total Capacity: gall <br /> 120 Product Type: 15W-40 <br /> ons <br /> mulative for containers by product type) Install Date: Service Dept(portable) <br /> ❑X Tank (2820) ❑ Containers (2821) #of Containers: TA#: 51:203162 <br /> 4 120 Product Type: 5W-20 (spl <br /> Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: northwest Service Dept <br /> ❑X Tank (2820) ❑ Containers (2821) #of Containers: TA#: J�rj,1' D_�1 <br /> 5120 Product Type: 15W-40 (split tank) <br /> Total Capacity: gallons <br /> (per tank or cumulative for containers by product type) Install Date: northwest Service Dept <br /> Total Capacity this Page: 600 gallons Total Capacity for Site: ' '.� ��'U gallons <br /> Comments: <br /> EHD Inspector: ReviewedDate: I 1 Entered Date: <br /> By Initial: �U� 1/rl By Initial: 7 <br /> 'Aboveground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum <br /> "Container means a storage device designed to be moved when full. <br /> EHD 28-01 REV 06/03/10 AST SURVEY FORM <br />