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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 0-g-( � "aw Facility ID# k(O Qz- <br /> Facility Address A.Ar Ma s6aa c- City zip <br /> Facility Phone # Facility Contact (OB&L 0 06kP <br /> Inspection Date: 4 Inspection Type: <br /> UST: Dual Wall_ gingle Wall_ 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 /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&S 252841 <br /> Forms A & B current c <br /> Monitoring/Maintenance Records L23CCR 2712 (b) ] <br /> Financia Responsibility LH&S 25292.2 (a) ] <br /> monitoring Records vai a e <br /> -J=CR 27121 <br /> monitoring Plan <br /> Response Plan 23CCR 2632 (d) (2) ] <br /> Unauthorized Releases Reported H& 25295 <br /> Monitoring Equipment Annual Test 23CCR 2630 <br /> ver spill on ainer <br /> Permitted UST Repairs 23CCR 2661 <br /> Permitted Upgrades [23CCR 26601 <br /> catnodic 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 /> Daily Stickreading CR 44 c 1 <br /> Gauging Stick in 1/8 inches [23CCR 2646 (c) (1) (E) ] <br /> STATISTICAL INVENTORY RECONCILIATION SIR <br /> Excessive Variation Reported L23CCR 2646.1(d) <br /> Integrity es every two years <br /> Annua SIR Report 23CCR 2646.1 <br /> Daily stick ReacLing L23CUR 2b4b tC) <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 GAUGINGT <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annual Tank Integrity Test L23CCR 2645 (b) ] <br /> PIPING MONITORIN <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 L23CCR 2643 c 2 <br /> Annual ea a ec or test L23CCR App.lV(1) (d) j <br /> SYSTEM STATUS: Major Violations No Violations <br /> COMMENTS Wc <br /> � Get Kc <br /> • <br /> RENS: RECEIVED By. <br /> TITLE• PHONE: DATE: <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />