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SAN JOAQUIN COUNTY ENVIRONMENTAL 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: Holz Rubber Company Page 1 of I Facility Address: City: Inspection Date: 1129 S. Sacramento St. Lodi, CA 95240 Lodi Mar 9, 2012 FA#: PR#: Pro ram Element: XWl m q° a 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. Q 2820 #of Containers: TA#: Ot5�0 Tank �S ( ) ❑ Containers (2821) 1 3,000 Product Type: oil Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: unknown X❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 1`jSa2D��o 2 3,000 Product Type: oil Total Capacity: gallons (per tank or cumulative for containers by produq type) Install Date: unknown ❑ Tank (2820) ❑X Containers (2821) #of Containers: 18 TA#: 46- 3 Total Capacity: 990 gallons Product Type: used oil (per tank or cumulative for containers by product type) Install Date: unknown ❑ Tank (2820) ❑X Containers (2821) #of Containers: 31 TA#: 4 1,705 Product Type: oil Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: unknown ❑ 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: 8,695 gallons Total Capacity for Site: 8,695 gallons Comments: AST survey done today. EHD Inspector Reviewed n Date: /� Entered Date: By Initial: J\" 3 l (� By Initial: *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 FORM