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,i <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 Cad 7-C? (aQn Facility ID# <br /> Facility Address W ti r City a:nQ&ktc,a Zip <br /> Facility Phone # Facilit Contact =p$AL Ct40k7 0) <br /> Inspection Date: Inspection Type: `_ <br /> UST: Dual Wall_ Single Wall_ OVERFILL: Audible_ Visilal_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 /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&S 252841 <br /> orms A & P Curren c <br /> Monitoring/Maintenance Records <br /> Financial Responsibility [H&S 25292.2 (a) ] <br /> Monitoring Recoras Available <br /> Monitoring Plan <br /> Response P an 23CCR 2632 (d) (2) ] <br /> Unauthorized Releases Reported H&S 25295 <br /> Monitoring Equipment Annual Test 23CCR 2630 <br /> over spill on ainer <br /> Permitted UST Repairs [23CCR 2661 <br /> Permitted Upgrades [23CCR 26601 _ <br /> Cathodic Protection a <br /> MANUAL INVENTORY RECONCILIATION MIR <br /> UST Integrity Test [23CCR 2643.11 <br /> Annual MIR Report 23CCR 2646 <br /> Meters Calibrated [23CCR 2646 (e) (4) ] <br /> Dai Stickreading CCR 44 c 1 , <br /> Gauging Stick in 1/8 inches [23CCR 2646 (c) (1) (E) ] Q �„ C�� Gad) <br /> STATISTICAL INVENTORY RECONCILIATION SIR <br /> Excessive Variation Reported L23CCR 2646.1(d) <br /> UST integrity es every two years <br /> Annual SIR Report L23CCR 2646.1 (1) J <br /> ai y Stick Reaaing L23CUR 2b4b kC) <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 GAUGING MT S ( cyy <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annua Tank Integrity Test L23CCR 2645 b A L i C <br /> PIPING MONITORI <br /> Daily Suction Piping Monitoring [23CCR App.III <br /> Piping Tightness Test [23CCR 2643 (b) , (c) , (d) ] <br /> Gravity Piping este every 2 years e <br /> Monthly Line Test 23CCR 2643 c 2 <br /> Annual ea etec or test L23CCR App.1V(1) (a) J <br /> SYSTEM STATUS: Major Violations No Violations <br /> COMMENTS V\S <br /> :AMtck(t <br /> REHS: RECEIVED BY: <br /> �'J(2'r Q" <br /> TITLE. PHONE: DATE: <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />