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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 t Facility ID# 0 lv / �� <br /> Facility Address CadCj L:, City -% 6 zip 3— <br /> Facility Phone # Facility Contact <br /> Inspection Date: , --,,Z_ - Inspection Type: b _ <br /> UST: Dual Wall_ Single Wall_ OVERFILL: Audible_ Visual_Mechanical_ <br /> UST Monitoring Alternative UST Contents <br /> PIPING SYSTEM: Dual Wall Single Wa11Suction Pressure Gravity <br /> Does the leak detection system shut off the pump automatically? YES_ NO <br /> VIOLATIONS <br /> # <br /> UST GENERAL REQUIREMENTS TANK <br /> Permit to Operate [H&S 252841 <br /> orms A & 6 curren c <br /> on>. orin ain enance Records <br /> Financial Responsibility LH&S 25292 .2 a <br /> Monitoring Recoras Available jz3ut�x 2. 112j <br /> monitoring an <br /> Response Plan 23CCR 2632 2 <br /> Unauthorized Releases Reported LH&S25295J <br /> Monitoring Equipment Annual Test 23CCR 263777 <br /> over spill on ainer <br /> Permitted UST Repairs 23CCR 2661 <br /> Permitted Upgrades [23CCR 26601 <br /> cathodic ro ec ion a <br /> MANUAL INVENTORY RECONCILIATION MIR <br /> UST Inte rite Test [23CCR 2643.11 <br /> Annual MIR ROrt <br /> 2646 <br /> Meters Calibrated [23CCR 2646 (e) (4) ] <br /> Daily Stick rea-ai—nq 123CCR 2446 (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 ever wo ears <br /> Annua SIR Report 23CCR 2646.1 <br /> aa, y ScicK Keaaing L2JUCR 2646 tC) (.L) j <br /> AUTOMATIC TANK GAUGING ATG <br /> Monthl ATG Results [3CCR 2643 (b) (1) ] <br /> Annus ATG Summary Report 23CCR 2712 b 2 <br /> MANUAL UST TANK GAUGING MT <br /> Tank Gau in Weekl [23CCR 2645 (b) ] <br /> Annua Tan Integrity Test 23CCR 2645 <br /> PIPING MONITORING <br /> Daily Suction Piping Monitoring 123CCR App.III <br /> Piping Tightness Test [23CCR 2643 (b) , (c) , (d) ] <br /> Gravity Piping este every 2 years e <br /> Monthly Line Test L23CCR 2643 c 2 <br /> Annual ea a ec or est L2=k App. 1) <br /> SYSTEM STATUS: Major Violations No Violations <br /> CO ENTS: L�Lv L <br /> 99<Y <br /> REHS� L ry G RECEIVED BY: •C7 �� i �� � <br /> TITLE: � '�`J % PHONE: (4 0,1_� DATE: <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 0 <br />