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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 -- 6, r,2tr Facility 1&# 73 Z 4 -, <br /> Facility AddressCity zip <br /> Facility Phone # Facility Contact <br /> Inspection Date : Inspection Type : <br /> UST : Dual Wall_ ingle Wa 1JZ OVERFILL . Audible_ Visual_Mechanical_ <br /> UST Monitoring Alternative UST Contents <br /> PIPING SYSTEM : Dual Wall Ingle 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 & B current c <br /> onitorin ainRecords ecords 1 <br /> Financia Responsibi ity LH&S 25292 . 2 a <br /> Monitoring Recoras Availanie L23CUR A4 / 12J <br /> Monitoring Plan 1 <br /> Response Plan 23CCR 2G32 ( d ) ( 2 ) ] <br /> Unauthorized Releases Reported[ H&S 25295 <br /> Monitoring Equipment Annual Test L23CCR 2630 <br /> ver spill on ainer ) ) <br /> Permitted UST Repairs [ 23CCR 26611 <br /> Permitted Upgrades [ 23CCR 26601 <br /> a no is rotesion 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 /> Daiiv Stick reading [ 23CCR 2446 ( 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 9-Tr— <br /> Annual 9- <br /> Tr-AnnualSIR Report L23CUR 2646 . 1 ( 7 ) <br /> ai y 6ticK Reacling tc <br /> AUTOMATIC TANK GAUGING ATG <br /> MonthlATG Results [ 3CCR 2643 ( b ) ( 1 ) ] <br /> Annua ATG Summary Report L23CCR 2712 ( b ) 2 <br /> MANUAL II T TANK GAUGING MTG <br /> Tank Gau in Weekl [ 23CCR 2645 ( b ) ] <br /> Annual Tank Integrity Test 23CCR 2645 b <br /> PIPING MONITORING <br /> Daily Suction Pining Monitoring [ 23CCR Apn . II ] <br /> Piping Tightness Test [ 23CCR 2643 ( b ) , ( c ) , ( d) ] <br /> Gravity PiDinq Testedevery 2 years [ 22CCR4 e <br /> Monthly Line Test L23CCR 2643 ( c ) ( 2 ) 1 <br /> Annual eax Oetector test L23CCR Aup . ll ) j <br /> I <br /> SYSTEM STATUS : Major Violations No Violations <br /> COMMENTS : G` L-.- <br /> REHS : /�.✓' RECEIVEZI <br /> TITLE : l li.Y IU WI rJ�I�M�"C� PHONE : DATE : <br /> Revised Date 1 / 29 / 97 23 CCR UST Regs May 5 , 1994 <br />