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PUBLIC HEALTH SERVICES SAU `70AQU22� <br /> 304 E. <br /> Weber <br /> ENVe]ME AL HEALTH DIVISION <br /> weber Third Floor <br /> 209/468- ' Stockton, CA 95< <br /> 3420 <br /> UNDERGROUND TANK PRO <br /> Facilit GRAM OFFICIAL INSPECTION <br /> Facility Name REPORT <br /> Facility Address Facility ID# L <br /> Facility Phone # 3 � <br /> Inspection Date: _ L FacilityCi <br /> Contact Zi <br /> UST: Dual Wall Sin 11 p <br /> UST Monitoring Sing Inspection Type. <br /> Alternative -� OVERFILL: Audible <br /> PIPING SYSTEM: Dual j�� s Visua <br /> Does the leak detection Sal —` UST Contents Mec anical� <br /> system Ingle Wall Suctio ` <br /> shut off the p� automat'C1 allysure Gravity <br /> UST GENERAL RE UIREMENTS VIOLATIONS NO_� <br /> Permit to Operate [H&S 25284] TANK # <br /> Forms curren <br /> onitorin alntenance .ecor s c <br /> Financial Responsibi_:ty H&S 25292,2 a <br /> Monitoring Recor s vii a e <br /> ni oringan <br /> Response Plan <br /> 23CCR�2632 2 <br /> Unaut orIz Releases Re orte H&S <br /> Monitoring Equipment Annua Test 5295 <br /> er s 1 on alner 23CCR 2630 <br /> Permuted UST Re airs 23CCR 2661 <br /> Permitted Upgrades [23CCR 26601 ' <br /> aL O 1C rO eC lOn <br /> a <br /> MANUAL INVENTORY RECONCILIATION MIR <br /> UST Inte rit Test [23CCR 2643 .1] <br /> Annual MIR Re ort 23CCR 2646 <br /> Meters Calibrated [23CCR 2646 (e) (4) ] <br /> Dal St1c tea 1n CCR 44 <br /> Gau in Stick in 1/8 inches [23CCR 2646 (c) (1) (E) I <br /> STATISTICAL INVENTORY RECONCILIATION SIR <br /> Excessive Variation Reported [23CCR 2646.1 d) ] <br /> n egri es ever wo ears <br /> Annua SIR Report 23CCR 2646.1 1 <br /> ai y is ea Ing <br /> c <br /> AUTOMATIC TANK GAUGING ATG <br /> Monthl ATG Results [3CCR 2643 (b) (1) ] <br /> Annua ATG Summa Re ort 23CCR 2712 b <br /> 2 <br /> AL T TANK GAUg.r MTG <br /> Tank Gau in Week] [23CCR 2545 (b) ] <br /> Annua Tank Integrity Test 23CCR 2645 b <br /> PIPING MONITORI <br /> Dail Suction Pi in Monitorin [23CCR A <br /> Piping Tightness Test [23CCR 2643 II] <br /> ravlt 1 in este (b) , (c) , (d) ] <br /> Monthly Line Test ever ears <br /> 23CCR 26437 2 e <br /> nua ea etec or test <br /> Pp.l 1 <br /> SYSTE_ M STATUS. Major Violations <br /> — � No Violations <br /> COMME S: <br /> RERs: n P f,;� b _ <br /> RECEIVED BY: <br /> TITLE*._Ot/V6� PHONE: Aj�_�4 _ <br /> � DATE• Z-7-K -7 <br /> Revised Date Z/29/97 23 CCR UST Regs May 5, 1994/ <br />