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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 •-�; ,� �( Facility ID# <br /> Facility Address It{$RMw� City AAh Zip <br /> Facility Phone # facility Contact ,,(f -544 iL, <br /> Inspection Date: '� Inspection Type: <br /> MIR UST: Dual Wall�__� Wall_ OVERFILL: Audible_ Visual— <br /> Mechanical-UST Monitoring"Alternative UST Contents <br /> PIPING SYSTEM: �-A Dual Wall Single Wall Suction Pressure Gravity <br /> Does the leak detection system shut off the pump automatically? YES NO <br /> VIOLAfifiI__0NS <br /> # <br /> UST GENERAL REOIIIREMENTS TANK ago A* <br /> Permit to Operate [H&S 252841 <br /> Forms A & B curren c <br /> one orin ain enance Records [23CCR 2712 (b) j <br /> Financial Responsibility [H&S 25292.2 a <br /> one oring Records Available <br /> monitoring Plan <br /> Response Plan 23CCR 2632 (dY-(2) 7— <br /> Unauthorized Releases Reported H&S 25295 <br /> Monitoring Equipment Annual Test L23CCR 2630 <br /> over spiii container <br /> Permitted UST Repairs 23CCR 2661 <br /> Permitted Upgrades [23CCR 2660] <br /> Catnodic Protection a <br /> MANUAL INVENTORY RECONCILIATION MIR <br /> UST Integrity Test [23CCR 2643.11 <br /> Annual MIR Re ort23CCR2646 <br /> Meters Calibrated [23CCR 2646 (e) (4) ] <br /> Dailv Stickrea in CR 2"6 (c) (1) <br /> Gauging Stick in 1/8 inches [23CCR 2646 (c) (1) (E) ] <br /> STATISTICAL INVENTORY RECONCILIATION 3IR <br /> Excessive Variation Reported 23CCR 2646.1 (d) <br /> UST Integrity es ever wo ears <br /> AnnualSIR Report 23CCR 2646.1 7 <br /> ai y stick Reading c <br /> AUTOMATIC TANK GAUGING ATG <br /> Monthly ATG Results [3CCR 2643 (b) (1) ] <br /> Ann ua ATG Summary Report 23CCR 2712 b 2 <br /> MANUAL UST TANK GAUGING T <br /> Tank Gau in Weekl [23CCR 2645 (b) ] <br /> Annua Tan Integrity Test 23CCR 2645 <br /> PIPING MONITORING <br /> Daily Suction Piping Monitoring [23CCR A .II] <br /> Piping Tightness Test [23CCR 2643 (b) , (c) , (d) ] <br /> Gravity i ineste ever ears e <br /> Monthly Line Test 23CCR 2643 c 2 <br /> Annual ea etector es pp.l 1 <br /> SYSTEM STATUS: Major Violations No Violations <br /> COMMENTS: 6&E- dcL if <br /> REHS: RECEIVED BY: <br /> TITLE: PHONE: DATE: <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />