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DATE �[ <br />SAN JOAQUIN COUNTY RT NT PR# �, 3 <br />ENVIRONMENTAL HEALTH DEPAPAGE <br />304 E. Weber Ave., Third Floor, Stockton, CA 95202 <br />(209)468=3420 <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility NameFacility Address E - �-e::� <br />Facilty Contact �� �t Title rfY��1.� Phone # <br />O <br />UST# Productj��_ UST#Product US Product�UST# Produccct <br />Overfill Prevention: ❑ Audible/Visual mechanical Monitoring Panel: of <br />Piping System: ❑ Gravity )CPressure ❑ Suction Violations:P.4inor ❑Major <br />D <br />Automatic Pump Shut own Satisfies CCR 2636 (g): ❑ Yes\Vj4o Dispenser Pan: fifes ❑ No <br />ade <br />INSPECTION TYPE: outirte�onng Certification ❑Complaint ❑Install ❑Removal ❑Repair/Upgr <br />COMPANY NAME: ,��. <br />tt ECHNICIAN NAME: t PHONE: �J <br />r <br />VIOLATIONS) <br />The above facility is not in compliance with the following section(s) of Health & Safety Code (HSC) and/or <br />California Code of Regulations (CCR): <br />1 <br />HSC 25284 <br />Permit to operate <br />2 <br />CCR 2637 <br />Secondary cont testing (6 <br />23 CCR 2630 (d) <br />Annual monitoring certification <br />month/36 month) <br />3 <br />CCR 2711(b) & (c) <br />Current State Forms A & B <br />4 <br />HSC 25292.2 <br />Certification of financial <br />Triennial tightness test of <br />i <br />