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PUBLIC HEALTH SERVICES SAN JOAQUIN COUNTY i <br /> ENVIRONMENTAL HEAL DIVISION ' <br /> 304 E. Weber Ave. , Third Floor, Stockton, CA 95202 <br /> 209/468-3420 <br /> I <br /> MMERGROUND TANK PROGRAM OFFICIAL INSPECTION REPORT <br /> Facility Name a ility ID# <br /> Facility Address City Zip <br /> Facility Phone # !T, Air3 9, Facility Contact <br /> Inspection Date: - Inspectio Type: <br /> UST: Dual Wall_ Single 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 curren c <br /> cna Orin aintenance _ecor s <br /> TT=rl)7T— <br /> Financial Responsibility LH&S 25292.2 (a) ] <br /> Monitoring Records Availanle <br /> Monitoring Plan <br /> Response P an L23CCR 2632 (d) (2) ) <br /> Unaut orize Re eases Reported H&S 25295 <br /> Mcnitoring Equipment Annual Test L23CER 263 <br /> over spill on ainer <br /> Permitted UST Repairs 23CCR 2661 <br /> Permitted Upgrades [23CCR 26601 <br /> Cathodic rotec ion L23CCIZ Zb.Jb ta) <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 Stick reading CCR 446 c 1 <br /> GaH2inq Stick in 1/8 inches [23CCR 2646 (c) ( ) (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 (3)) <br /> as y stick 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 GAII MT <br /> Tank Gau in Weekl [23CCR 2645 (b) ] <br /> Annua Ta Integrity Test 23CCR 2645 <br /> PIPI G MONITORING <br /> Daily Suction Pipiaa Monitoring [23CCR A I] <br /> Piping Tightness Test [23CCR 2643 (b) , (c) , (d ] <br /> Gravity Piping este every 2 years L23cr-R !643 (-e77- <br /> Monthly <br /> eMonth y Lane Test L23CCR 2643 (c) (2) 1 <br /> Annuai LeakDetector test pp. 1 <br /> SYSTEM STATUS: Major Violations No Violations <br /> COMMENTS: <br /> REH RECEIVED BY: c� <br /> TITLE: PHONE 3 / DATE: <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />