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• <br />PUBLIC HEALTH SERVICES SAN <br />ENVIRONMENTAL HEALTH <br />304 E. Weber Ave., Third Floor, <br />209/468-3420 <br />0 <br />JOAQUIN COUNTY <br />DIVISION <br />Stockton, CA 95202 <br />UNDERGROUND TANK PROGRAM OFFICIAL INSPECTION REPORT <br />Facility Name C-; 1 t, S .a I's Q Facility I# <br />Facility Address 44-215nL 1, ZcxyWf> City Zip <br />Facility Phone #aZq 56CL Facility Contact <br />Inspection Date: Inspection Type: <br />UST: Dual Wall Single Wall_ OVERFILL: Audible Visual Mechanical <br />UST Monitoring Alternative i�in�l�t��ynev�S UST Contents �,£tkE'L <br />PIPING SYSTEM: *j[ Dual Wall Single Wall X Suction_%,,.Pressure Gravity <br />Does the leak detection system shut off the pump automatically? YES_ NO <br />VIOLATIONS <br />1/'►LYA }} <br />UST GENERAL REQUIREMENTS <br />Permit to Operate [H&S 25284] <br />orms A & B current c <br />one orin ain enance Records <br />-fi'nancial Responsibility LH&S 25292.2(a)] <br />monitoring Recoras Available L23CUR 2/1:9J <br />Monitoring Plan <br />Response Plan 23CCR 2632 2 <br />Unauthorized Releases Re orte H& 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 />catnodic Protection L23CCR 2635ta) <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 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 />USr integrity es every two years <br />Annua SIR Report L23CCR 2646.1 <br />D-a-TTy=TcX Reading c <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 />-7Fn-u-a-1—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 • <br />RENS: <br />TITLE: <br />RECEIVED BY: <br />PHONE: <br />DATE: <br />Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />7 <br />