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PUBLIC HEA17H 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 D�.�• C <br /> Facility Address_ 1l�y2r+ �_ Facility ID# <br /> Facility Phone # <br /> t Zip <br /> Facility Contac <br /> Inspection Date: •,��• <br /> UST: Dual Wall Inspection Type: n <br /> UST Monitoring AlternativeUST <br /> _ in le Wall OVERFILL: Audible_ Visual_Mechanical_ <br /> UST Contents <br /> PIPING SYSTEM: Dual Wall Single Wall—�_Suction�_Pressure Gravity <br /> Does the leak detection system shut off the pump automatically? YES_ NO_ <br /> VIOLATIONS <br /> UST GENERAL REOIIIREMENTS TANK # <br /> Permit to Operate [H&S 25284] <br /> orms A & B Curren c <br /> Mon l orin aln enance Records <br /> Financia Response i ity H&S 25292.2 a <br /> monitoring Recorcis Available L23CCH 2712J <br /> monitoring Plan <br /> Response Plan L23CCR 2632 (d) (2) ] <br /> Unauthorized a eases Report'9d LH&S 25295J <br /> Monitoring Equipment Annual Test L23CCR 2630 <br /> over spill on ainer <br /> Permitted UST Repairs 23CCR 2661 <br /> Permitted Upgrades [23CCR 26601 <br /> CattiocLic Protection a <br /> MANUAL INVENTORY RECONCILIATION MIR <br /> UST Inte rit Test [23CCR 2643 .11 <br /> Annual MIR Re ort 23CCR 2646 <br /> Meters Calibrated [23CCR 2646 (e) (4) ] <br /> Daily tic reading CR 44 c 1 <br /> Gauging Stick in 1/8 inches [23CCR 2646 (c) (1) (E) ] <br /> STATISTICAL INVENTORY RECONCILIATION SIR <br /> Excessive variation Reported 23CCR 2646.1(d) ] <br /> USI integrity es every two years <br /> Annual SIR Report L23CUR 2646.1 7 <br /> Daily sticit Reacling c <br /> AUTOMATIC TANK GAUGING ATG <br /> Monthl ATG Results [3CCR 2643 (b) (1) ] <br /> Annus ATG Summary Report 23CCR 2712 b 2 <br /> MANUAL T TANK GAUGINGMT <br /> Tank Gal in Weekl [23CCR 2645 (b) ] <br /> Annua Tan Integrity Test 23CCR 2645 <br /> PIPING MONITORING <br /> Daily Suction Piping Monitoring [23CCR A .II] <br /> Piping Tightness Test [23CCR 2643 (b) , (c) , (d) ] <br /> Gravity i in es a every 2 years L23CCR TU0737 <br /> Monthly Line Test G23CUR 2643 c 2 <br /> Annual ea Detector test L23CCR App.lV(1) (CL) j <br /> SYSTEM STATUS: Major Violations No Violations <br /> COMMENTS: trt Q- u Z <br /> 1 <br /> REHS: ..,G RECHIVED BY. <br /> TITLE: ew ! PHONE: DATE: <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />