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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 , ,Q ��� Facility ID# <br /> Facility Address ^ ;f7 _City zip <br /> Facility Phone # 2 Facility Contact AL) <br /> Inspection Date: Inspection Type: <br /> UST: Dual Wall_ 'in le Wal I� _ OVERFILL: Audible_ Visual_Mechanical_ <br /> UST Monitoring Alternative !� UST Contents <br /> PIPING SYSTEM: Dual Wall—t Single Wall Suction Pressure_Gravity <br /> Does the leak detection system shut off the pump automatically? YES NO_ <br /> IONS <br /> TANK # <br /> nb.)'�S 57"1 <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&S 25284] <br /> m <br /> ors curren c <br /> Monitoring/Main enance .ecor s <br /> Financia Response i ity H&S 25292.2 (a) ] <br /> monitoring Records vai a e <br /> one orin an <br /> Response P an 23CCR 2632 2 <br /> Unautnorizea Re eases Re or a H& 25 <br /> Monitoring Equipment Annus Test 23CCR 2630 <br /> ver s i on ainer <br /> Permitted UST Re arra 123 CR 2661 <br /> Permitted Upgrades [23CCR 2660] <br /> CathodiC Protection a <br /> MANUAL INVENTORY RECONCILIATION MIR <br /> UST Inte ret Test [23CCR 2643.11 <br /> Annual MIR Report 23CCR 2646 <br /> Meters Calibrated [23CCR 2646 (e) (4) ] <br /> ai tic res in 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 /> usr integrity es ever wo ears <br /> Annual SIR Report Lz3CCR 2646.1 <br /> ai y i ea ing such dbqb kC) k1) J <br /> ASITOMATIC TANK GAIIGING ATG <br /> Monthl ATG Results [3CCR 2643 (b) (1) 1 <br /> Annual ATG summary Re ort L23CCR 2712 2 <br /> MANUAL UST TANK GAUGING (14TG) <br /> Tank Gal in Weekl [23CCR 2645(b)] <br /> Annua Ta Integrity Test 23CCR 2645 <br /> PIPI MO ITO I <br /> Dailv Suction Piping Monitorin [23CCR A .III <br /> Piping Tightness Test [23CCR <br /> Gravity i in este ever ears e <br /> Mont ly Line Test 23CCR 2643 c 2 <br /> ua ea a ec or ea pp• <br /> SYSTEM STATUS: Major Violations No Violations <br /> COMMENTS:- <br /> REHSe�( -�0- +�-+�� "y�V•�+'�— RECEIVED BY: <br /> TITLE• <br /> PHONE: DATE: <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />