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0 10 <br /> 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 Facility ID# <br /> Facility AddressCity zip <br /> Facility Phone 111qtZ Facility Contact V4KgjWjfiA" L� „�„ "I_ <br /> Inspection Date: Inspection Type: IF=') �' <br /> UST: Dual Wall Sin 1 all_ OVERFILL: Audible Visual-�4_Mechanical_ <br /> UST Monitoring Alternative �S- +E- UST Contents p�.L <br /> PIPING SYSTEM: X�Dual Wall Single Wall_%,(,-Suction Pressure Gravity <br /> Does the leak d4tection 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 Curren c <br /> Monitoring/Maintenance ecor s <br /> Pinancial Responsibility LH&S 25292.2 (a) ) <br /> monitoring Recora-s—Mvalianie L23CUR 2112J <br /> monitoring PINE <br /> Response Plan L23CCR 2632 2 <br /> Unauthorized Releases Re orte H& 25295 <br /> Monitoring Equipment Annual Test L23CCR 2630 <br /> ver spill on ainer <br /> Permitted UST Repairs 23CCR 2661 <br /> Permitted Upgrades [23CCR 26601 <br /> Qathodic Protection 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 /> 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 /> UST integrity es every two years <br /> Annual SIR Report L23CCR 2646.1 <br /> Daily Sticr, ReNaing 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 /> -j9Tn—u-aT-Tank Integrity Test L23CCR 2645(b) ] <br /> PIPING MONITORING <br /> Daily Suction Piping Monitoring [23CCR A .II] <br /> Piping Tightness Test [23CCR 2643 (b) , (c) , (d) ] <br /> Gravity Piping este ever ears e <br /> Monthly Line Test L23CCR 2643 c 2 <br /> Annual ea Detector test [23CCR App.ITFITITJ <br /> SYSTEM STATUS: Major Violations No Violations <br /> COMMENTS: <br /> REH RECEIVED BY: <br /> TITLE• PHONE: <br /> Revised Date 1/29/97 23 CCR UST Regs May 1994 <br />