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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 Facility ID# 1,5Y!: <br />Facility Address a , /�C� �"cF�t �, �, City Zip <br />Facility Phone # Facility Contact <br />Inspection Date:,iT�7 Inspection Type: <br />UST: Dual Wall �y / Wall_ OVERFILL: Audible_ Visual_ Mechanical_ <br />UST Monitoring Alternative USTCo tents t ,, W--<, <br />�. �, �_-;- , cam— " <br />PIPING SYSTEM: Dual Wall '�Single Wall Suction Pressure Gravity <br />Does the leak detection systerK shut off the pump automatically? YES_ NOZ <br />VIOLATIONS <br />UST GENERAL REQUIREMENTS <br />Permit to Operate [H&S 252841 <br />orms A & b current c <br />Monitoring/Maintenance Records <br />771—nanciai Responsibility [H&S 25292.2 a <br />Monitoring Records Available L23CCH 2/121 <br />Monitoring Plan x <br />Response Plan L23CCR 2632(d)(2)] <br />Unaut orize Re eases Reported H&S 25295 <br />Monitoring Equipment Annual Test 23CCR 2630 <br />over spill on ainer <br />Permitted UST Repairs 23CCR 2661 <br />Permitted Upgrades [23CCR 2660] <br />Cathodic ro ec ion 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 Stick reading [23CCR 44 c 1 <br />Gauging Stick in 1/8 inches [23CCR 2646(c)(1)(E)] <br />STATISTICAL INVENTORY RECONCILIATION SIR <br />Excessive Variation Reported [23CCR 2646.1(d) <br />USI Integrity es every two years <br />Annual SIR Report L23CCR 2646.1 <br />Daily stick Reading L23CUR 2b4b tC)(i)J <br />AUTOMATIC TANK GAUGING ATG <br />Monthly ATG Results [3CCR 2643(b)(1)] <br />Annual ATG Summary Report 23CCR 2712 b 2 <br />AL UST TANK GAUGING MT <br />Tank Gauging Weekl [23CCR 2645(b)] <br />Annual Tank Integrity Test 23CCR 2645(b)] <br />PIPING MONITORING <br />Daily Suction Piping Monitoring [23CCR App.III <br />Piping Tightness Test [23CCR 2643(b),(c),(d)] <br />Gravity-Pipingeste every 2 years L23CCR 2643(e)] <br />Monthly Line Test L23CCR 2643 c 2 <br />Annual ea etector test L23CCR App.lV(1)(d)j <br />SYSTEM STATUS: Major Violations No Violations <br />COMMENTS: <br />REHS :t�,GG rZc�/ V 1� RECEIVED B <br />TITLE: <br />PHONE: <br />DATE: <br />Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />