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PUBLIC HEALTH SERVICES SAN JOAQU•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 I # 1 <br /> Facility Address City Zi <br /> Facility Phone # / Facility Contact p <br /> Inspection Date: Inspection Type: <br /> IF <br /> UST: Dual Wall_ Ingle Wall OVERFILL: Audible_ Visual Mechanical_ <br /> UST Monitoring AlternativeUST Contents <br /> PIPING SYSTEM: Dual Wall, Ingle Wall Suction_Lpressure Gravit <br /> Does the leak detection systefn shut off the pemp automatically? YES_ NO <br /> VIOLATIONS <br /> UST GENERAL REQUIREMENTS TANK # o D <br /> Permit to Operate (H&S 25284] <br /> orms Curren c <br /> one Orin ain enance Recor s <br /> Financia Response i ity H&S 25292.2 a <br /> one oring ecor s vai a e <br /> Monitoring Pian <br /> Response P an 23CCR 2632 2 <br /> Unaut or . Re eases a ort; H& 2 295 <br /> Monitoring Equipment Annus Teat 23CCR 2630 <br /> vers i on ainer <br /> Permitted UST Re arra 23CCR 2661 <br /> Permitted Upgrades [23CCR 26601 <br /> a o is ro ec ion a <br /> MANUAL INVENTORY RECONCILIATION MIR <br /> UST Inte ret Test 123CCR 2643.1] <br /> Annual MIR Re ort 23CCR 2646 <br /> Meters Calibrated [23CCR 2646 (e) (4) ] <br /> ai tic res in R 44 c 1 <br /> auginStick in 1/8 inches [23CCR 2646 (c) (1) (E) ] <br /> STATISTICAL INVENTORY RECONCILIATION SIR <br /> Excessive Variation Reported 23CCR 2646.1 (d <br /> ­ICemXICV luatevery rwn tears <br /> Annus SIR Report L23CCR 2646.1 <br /> ai y buicK Ke— <br /> AUTOMATIC TANK GAUGING ATG <br /> MonthlyATG Results (3CCR 2643 (b) (1) ] <br /> Annus ATG Summar Re ort L23CCR 2712 2 <br /> MANUAL UST TANK GAUGING <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annuai ianx Integrity Test 23CCR 2645 <br /> PIPING M <br /> -No—IjITORING <br /> Dail SuctionPi in Monitorin 23CCR A .II] <br /> Piping Tightness Test [23CCR 2643 (b) , (c) , (d) ] <br /> "'EX P121ngea a ever ears e <br /> "'o""-'Y Line Test L23CCR 2643 c 2 <br /> Annuai Leaka ec or Lesu LZJUCR App.IV <br /> SYSTEM STATUS: Major Violations No Violations <br /> COMMENTS:—'-:aF'f_ Z <br /> RENS: 'V L —RECEIVED <br /> ^ BY: <br /> TITLE: e vJwt� PHONE: (-NO aJ-/7yy .7-C <br /> DATE• 7 ! 7 <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />