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PUBL77 HEALTH SERVICES SAN JOAQUT-'Z COUNTY <br /> ENVIRONMENTAL HEALTH .DIVIC_ <br /> 304 E. Weber Ave. , Third Floor, Stockton, CA 95202 <br /> 209/468-3420 <br /> UNDERGROUND TANK PROGRAM OFFICIAL INSPECTION REPORT" <br /> Facility Name orfiy4'to <br /> "_C'e,-. �l'iyu 5c-lz. 4 Facility ID# <br /> Facility AddressA!fA City Zip <br /> Facility Phone # Facility Contact <br /> Inspection Date: q- IV- Y Inspection Type: ` <br /> UST: Dual Wall_ Single allOVERFILL: Audible_ Visual Mechanical <br /> UST Monitoring Alternative UST Contents <br /> PIPING SYSTEM: Dual Wall Single WallSuction N _Pressure Gravity <br /> Does the leak detection system shut off the p p automatically? YES_ NOS <br /> VIOLATIONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&S 252843 <br /> Forms 5 curren c <br /> Monitoring/Maintenance Records <br /> Financial Responsibility LH&S 25292.2 (a) ] <br /> Monitoring Records Available L24CUR 27121 <br /> Monitoring Plan <br /> Response Plan L23CCR 2632 2 <br /> Unauthorized Releases Reported H& 25295 <br /> Monitoring Equipment Annual Test L23CCR 2630 <br /> over spill on ainer <br /> Permitted UST Repairs 23CCR 2661 <br /> Permitted Upgrades [23CCR 26601 <br /> Cattodic Protection L23CCR 2b35ka) t2) (A) J <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 tic readinq t23CCR 44 c 1 <br /> Gau in Stick in 1/8 inches [23CCR 2646 (c) (1) (E) ] <br /> STATISTICAL INVENTORY RECONCILIATION SIR <br /> Excessive Variation Reported 23CCR 2646.1(d) <br /> USI 141Cegrity Testevery two years <br /> Annual SIR Report L23CCR 2646.1(1) j <br /> Daily ScIcR Rgafflng c <br /> AUTOMATIC TANK GAUGING ATG <br /> Monthly ATG Results [3CCR 2643 (b) (1) ] <br /> Annual ATG Summary Report L23CCR 2712 (b) (2) ] <br /> MANUAL UST TANK GAUGING MT <br /> Tank Gau in Weekl [23CCR 2645(b) 3 <br /> Annual Tank Integrity Test 23CCR 2645 <br /> PIPING MONITORING <br /> Daily Suction Pi in Monitorin (23CCR An .II] <br /> Piping Tightness Test [23CCR 2643 (b) , (c) , (d) 3 <br /> Gravity Piping este every 2 years e <br /> Monthly Lane Test L23CCR 2643 c 2 <br /> ]Uinual EeakDetector test L23CCR App.1V(1) (d.) J <br /> SYSTEM STATUS: t Major Violations No Violations /f <br /> COMMENTS: ! 'f -AJr C3 .:*- S <br /> RENS: RECEIVED BY: <br /> TITLE: • PHONE: DATE: <br /> i <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />