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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 ---� "4" �- MGrFacility ID# <br /> Facility Address g.,(S `� F-k L c c~do CitySrockt� Zip �,5 3 / <br /> Facility Phone # C', E,,Z- QP,C, Facility Contact <br /> Inspection Date: Inspection Type: <br /> UST: Dual Wall/ Single Wall_ OVERFILL: Audible_ Visual_Mechanical_ <br /> UST Monitoring Alternative UST Contents <br /> PIPING SYSTEM: XDual Wall Single Wall Suction—_Pressure Gravity <br /> Does the leak detection system shut off the pump automatically? YES_ NO_ <br /> VIOLATIONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS e, <br /> Permit to Operate [H&S 252841 <br /> orms A & B current-, c <br /> Monitoring/Maintenance Records L23CCR 2712 (b) j <br /> Financial Responsibility [H&S 25292 .2 (a) ] <br /> Monitoring 7ecoras Avaliatie L23CUP 2 /121 <br /> -Monitoring Plan <br /> Response Plan 23CCR 2632 (d) (2) ] <br /> Unauthorized Releases Reported H&S 25295 <br /> Monitoring Equipment Annual Test 23CCR 2630 / <br /> over spill on ainer <br /> [23CCR 77777ETT— <br /> Permitted UST Repairs [23CCR 2661] <br /> Permitted Upgrades [23CCR 26601 <br /> Cathodic ro ec ion a <br /> MANUAL INVENTORY RECONCILIATION MIR <br /> UST Integrity Test [23CCR 2643.1] <br /> Annual MIR Report 23CCR 2646 <br /> Meters Calibrated [23CCR 2646 (e) (4) ] <br /> Daily Stick reading 23CCR 446 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 /> integrity es every two years g <br /> Annual SIR Report 23CCR 2646 .1 <br /> Daily SticK Reacting L23CCR 2646 kc) kl) j <br /> AUTOMATIC TANK GAUGING ATG <br /> Monthly ATG Results (3CCR 2643 (b) (1) ] <br /> Annual ATG Summary Report 23CCR 2712 b 2 <br /> MANUAL UST TANK GAUGIN MTG <br /> Tank Gauging Weekl [23CCR 2645 (b) ] <br /> Annual Tank Integrity Test L23CCR 2645 (b) ] <br /> PIPING MONITORING <br /> Daily Suction Piping Monitoring [23CCR App.III <br /> Piping Tightness Test [23CCR 2643 (b) , (c) , (d) ] <br /> Gravity Piping este every 2 years 2643 (e) ] <br /> Monthly Line Test L23CCR 2643 c 2 <br /> -Annual ea etector test R pp.! 1 <br /> SYSTEM STATUS: Major Violations f�No Violations �} q�, <br /> COMMENTS: L G'1 K L(Q C G�1 C l K - \�I'CCCk <br /> i <br /> RENS: ( �. RECEIVED BY <br /> TITLE: PHONE: DATE: <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />