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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 �� / � ]-��Facility Z �CJI <br /> Facility Address L (� ,4u1_9 City 7trv� Zip iJ <br /> Facility Phone # T-� Face ty Contact <br /> Inspection Date: - - Inspection Type: <br /> UST: Dual Wall Single Wa 1 OVERFILL: Audible_ Visual Mechanical <br /> UST Monitoring'A_lternativeF��-'yuair{i�UST Contents �;/'} � <br /> PIPING SYSTEM: Dual Wall Single Wall Suction��_Fres <br /> sure Grav}ty <br /> Does the leak detection system shut off the pump automatically? YES_ NO <br /> VIOLATIONS <br /> UST GENERAL REQUIREMENTS TANK # <br /> Permit to Operate [H&S 252841 <br /> orms A & B Curren C <br /> one orin ain enance ecor s <br /> Financia Response i ity H&6 25292.2 a <br /> one oring ecor s vai a e <br /> monitoring an <br /> Response P an 23CCR 2632 2 <br /> Unauthorized Re eases Re orted [H&S 25295 <br /> Monitoring Equipment Annuai Test 23CCR 2630 <br /> ver s i on ainer <br /> Permitted UST Repairs 123CCR 2661 <br /> Permitted Upgrades [23CCR 26603 <br /> (.:atnoalc Pro ec ion a <br /> MANUAL INVENTORY RECONCILIATION MIR <br /> UST Inte rit Test 123CCR 2643.1] <br /> Annual MIR Re ort23CCR 2646 <br /> Meters Calibrated [23CCR 2646 (e) (4) ] <br /> Daiiy Stickrea in [23CCR 244 c 1 <br /> Gauging Stick in 1/8 inches [23CCR 2646 (c) (1) (E) ] <br /> STATISTICAL INVENTORY RECONCILIATION SIR <br /> Excessive Variation Reported 53CF 2646.1 (d) <br /> uba n e ri es ever two ears <br /> AnnualSIR Report LZ3CCX 2646.1 ] <br /> ai y 6LICK Re ing c <br /> AUTOMATIC TANK GAUGING ATG <br /> Monthl ATG Results [3CCR 2643 (b) (1) ] <br /> Ann ua ATG Summar Re ort 23CCR 2712 b 2 <br /> M-XNUAL UST TANK GAUGINGMT <br /> Tank Gauging Weekl [23CCR 2645 (b) ] <br /> AnnualTan Integrity Test 23CCR 2645 <br /> PIPING MONITORING <br /> Dail Suction Pi in Monitorin [23CCR A .II] <br /> Piping Tightness Test [23CCR 2643 (b) , (c) , (d) ] <br /> Gravity Pipin, este eveLX 2 years e <br /> Monthly Line Test L23CCR 2643 c 2 <br /> Annuai Leaka ec or test L2pp, 1 <br /> SYSTEM STATUS: Major Violations No Violations <br /> COMMENTS- 3,— <br /> RENS: RECEIVED BY: c <br /> TITLE: PHONE: q& �✓& '-2DATE: <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />