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6 6 <br /> 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 �� �{ �Fat?CJ �V7lc� Facility ID# Z3 <br /> Facility Address_ iz City zip <br /> Facility Phone # L Facility Contact <br /> Inspection Date: _ Inspection Type: <br /> UST: Dual Wall_ Single 11_o OVERFILL: Audible_ Visua M eivifti.i.ical_ <br /> UST Monitoring Alternative UST Contents �aso�n,.r. <br /> ity / <br /> PIPING SYSTEM: Dual Wall ingle Wa11�Suction Pressure Grav <br /> Does the leak detection system shut off the pump automatically? YES_ NO V <br /> VIOLATIONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&S 252841 <br /> orms A & 6 current c <br /> Monitoring/Maintenance Records <br /> Financial Responsibility JH&S 25292.2 (a) ] <br /> monitoring Records AvailaiDie <br /> Monitoring Plan <br /> Response Plan L2.iCCR 2632 (d) (2) ] <br /> naut orize Re eases Reported H& 25295J <br /> Monitoring Equipment Annual Test L23CUR 2b3ukaTT <br /> ver spill on ainer <br /> Permitted UST Repairs 23CCR 2661 <br /> Permitted Upgrades [23CCR 2660] <br /> Catliodic Protection a <br /> MANUAL INVENTORY RECONCILIATION MIR <br /> UST Int; rit Test [23CCR 2643.11 <br /> Annual MIR Re ort 123CCR 2646 <br /> Meters Calibrated [23CCR 2646 (e) (4) ] <br /> Daily Stickres in R 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 /> integriLy Testevery two years <br /> Annual SIR Report L23CCR 2646.1 <br /> Daily stick Reading <br /> AUTOMATIC TANK GAUGING ATG <br /> Mon thl ATG Results [3CCR 2643 (b) (1) ] <br /> Annua ATG Summa Report L2suuR 2712 (b) (2) 1 - <br /> MANUAL T TANK GAUGING <br /> Tank Gau in Weekl [23CCR 2645(b) ] <br /> Annus Tan Integrity Test 23CCR 2645 b <br /> PIPING MONITORING <br /> Daily Suction Piping Monitoring [23CCR App.III <br /> Piping Tightness Test [23CCR 2643 (b) , (c) , (d) ] <br /> -ffrave i in es a ever ears e <br /> Monthly Line Test 23CCR 2643 c 2 <br /> Mnuai LeaRa ec or tesU LZ-3CCR App.lv(l) (d) ] <br /> SYSTEM STATUS: Major Violations/ No Violations <br /> CO E S <br /> REHS:y M 0 �� RECEIVED BY: <br /> TITLE: , PHONE: �e 7C- c3��� DATE:Z- <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />