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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 A. ,--4 Facility ID# _z]V7 <br /> Facility Address /IZbO. P1146 9r City '!-Pp) Zip � L. <br /> Facility Phone # 3 -oG" Facility Contact S7�v� )tz [rT <br /> Inspection Date: cr Inspection Type: <br /> UST: Dual Wall Single Waller OVERFILL: Audible_ Visual_Mechanical_ <br /> UST Monitoring Alternative UST Contents <br /> PIPING SYSTEM: Dual Wall,<Single Wall Suction_ _Pressure Gravity <br /> Does the leak detection system shut off the pump automatically? YES_ NO <br /> VIOLATIONS <br /> UST GENERAL REQUIREMENTS TANK # <br /> Permit to Operate [H&S 25284] <br /> orms A & B current c <br /> Monitoring/Maintenance Records <br /> Financial Response i lty LH&S 25292.2 (a) ] <br /> monitoring Recoras Availatie L23ucx 2 /12j <br /> monitoring Plan <br /> Response Plan 23CCR 2632 (d) (2) ] <br /> Unauthorized Releases Reported H& 2529-5j <br /> Monitoring Equipment Annual Test 23CCR 2630 <br /> over still on ainer <br /> Permitted UST Repairs 23CCR 2661 <br /> Permitted Upgrades [23CCR 2660] <br /> cathodic ro ec eon a <br /> MANUAL INVENTORY RECONCILIATION MIR <br /> UST Integrity Test [23CCR 2643.1] <br /> Annual MIR Report 23CCR 2646 X <br /> Meters Calibrated [23CCR 2646 (e) (4) ] <br /> Daily Stick readincr 123CCR 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 /> n egri es ever two ears <br /> AnnualSIR Report L2JUCH 2646.1 <br /> Daily St1cx Reading c <br /> AUTOMATIC TANK GAUGING ATG <br /> Utl ATG Results [3CCR 2643 (b) (1) ] <br /> ATG Summary Report 23CCR 2712 (b) (2) ] <br /> MANUAL UST TANK GAUGINGMT <br /> Tank Gal in Weekl [23CCR 2645 (b) ] <br /> Annua Tank Integrity Test 23CCR 2645 (b) ] <br /> PIPING MONITORING <br /> Faily Suction Piping Monitoring [232CR Llp,2.II] <br /> Piping Tightness Test [23CCR 2643 (b) , <br /> Gravity Piping este ever earse <br /> Mont y Line Test 23CCR 2643 c 2 <br /> Annualea a ec or test L23CCR App.lV(1) (dFT <br /> SYSTEM STATUS: Major violations No Violations <br /> COMMENTS: <br /> REHS: �-e- — Vd- RECEIVED <br /> TITLE: PHONE: DATE: <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />