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PUBLIC HEALTH SERVICES SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E. Weber Ave. , Third Floor, Stockton, CA 95202 <br /> 209/468-3420 <br /> UNDERGROUND TANK PROGRAM OFFICIAL INSPECTION REPORT <br /> Facility Name <br /> Facility Address Facility ID# 3_3 <br /> Facility Phone # City ' <br /> Inspection Date: Facility ontact 42e <br /> UST: Dual Wall Single all Inspection Type: � f�.n <br /> UST Monitoring P_lternative OVERFILL: Audible_ Visual <br /> PIPING SYSTEM: UST Contents Mechanical_ <br /> Dual Wall Si e allSuction <br /> Does the leak detection system shut off the Suctio�� p <br /> Pump automatic- y ure,�_Gravity <br /> Y• YES NO. <br /> UST GENERAL RE UIREMENTS TANK # VIOLATIONS <br /> Permit to Operate [H&S 25284] <br /> rorms m CurrenI ,/ <br /> onnai <br /> �torintenance ..ecoras c <br /> —73'-nanc-lai Responsibi 1t 1 J <br /> oni oring xecoras valYanHeS 25292.2 (a <br /> oni�oring lan <br /> Response P ani <br /> Unaut orize 23CCR 2633 2 ( 2 <br /> Re eases Reporte H&S 25295 <br /> Monitoring Equipment Annual Test <br /> on <br /> ver sn, ainer 23CCR 2630 J <br /> Permitted UST Repairs J <br /> Permitted U [23CCR 2661] <br /> Upgrades [23CCR 2660] <br /> a noaic rotectiori- <br /> b a <br /> MANUAL INVENTORY <br /> 2NC1264MIRUST Inte riTest [ CR3 11 <br /> Annual MIR Re ort 23CCR 2646 q <br /> Meters Calibrated [23CCR 2646 {e) (4) ] <br /> Dai v Stic rea incr CCR <br /> Gau in Stick in 1/8 inches2[23 c 2 <br /> [23CCR 2646 (c) (1) (E) ] I <br /> I <br /> NTORY <br /> ExcessiveAVariiat on Re port edl[23CCRN2641 (d) ]IR <br /> n egra est every two years <br /> Annua SIR Report (23CCR 2646.10 J g <br /> al y sic Rea ing 3 <br /> c J <br /> AUTOMATIC TANK GAUGING rATG <br /> Monthl ATG Results [3CCR 2643 (b) (1) ] <br /> Annuai AT Summary Report 23CCR 2712 b <br /> 2 I <br /> MANUAL II T TANK GAIIGI MTG <br /> Tank Gau in Weekl [23CCR 2645 (b) J <br /> Annual Tank Integrity Test 23CCR 2645 (b) <br /> PIPING MONITORING <br /> Daily Suction Piping Monitorin [23CCR Ann. I1] <br /> Piping Tightness Test [23CCR 2643 (b) , (c) (d) ] <br /> ravit 1pinq este <br /> Monthly Line Test every years <br /> 123CCR 2643 (c) (2) 4 e) <br /> Annua eax erector test <br /> l APP•1 1 a <br /> SYSTEM STATUS: Major Violations / <br /> No Violations___ <br /> COMMENTS: C! <br /> REHS: <br /> RECEIVED BY: <br /> TITLE: , <br /> ' PHONE: <br /> Revised Date 1/29/97 DATE: <br /> 23 CCR UST Regs May 5, 1 94 3 <br />