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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 C`;lEUQLbQyN Facility ID# <br /> Facility Address W City Zip <br /> Facility Phone # -3440 Facility Contact <br /> Inspection Date: $ -4 Inspection Type: u v� <br /> UST: Dual Wall„ Single Wall_ OVERFILL: Audible_ Visual_Mechanical� <br /> UST Monitoring Alternative UST Contents MV <br /> PIPING SYSTEM: k Dual Wall Single Wall Suction Pressure Gravity <br /> Does the leak detection system shut off the pump automatically? YESk NO_ <br /> „L V10 TIONS 3 <br /> TANK # L <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&S 25284] <br /> -Forms current c <br /> one orin ain enance Records <br /> Financial Responsibility LH&S 25292.2 a <br /> Monitoring Recorag Availanie <br /> monitoring an <br /> Response Plan L23CCR 2632 2 <br /> Unauttiorized Releases Reporte3 LH&S25-2551 <br /> Monitoring Equipment Annual Test 23CCR 2630 <br /> Over s i container <br /> Permitted UST Re airs 23CCR 2661 <br /> Permitted Upgrades [23CCR 26601 <br /> —CatnoUic Protection a <br /> MANUAL INVENTORY RECONCILIATION MIR <br /> UST Integrity Test [23CCR 2643.1] <br /> Annual MIR Report L23CCR 2646 <br /> Meters Calibrated [23CCR 2646 (e) (4) ] <br /> Dai t-icrea in 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 /> integrity es ever wo ears <br /> Annual SIR Report L23CCR 2646.1 <br /> ai y i ea ing c <br /> AUTOMATIC TANTO GAUGING ATG <br /> Monthly ATG Results [3CCR 2643 (b) (1) ] <br /> Annual ATG Summary Repo t L23CCR 2-11;& (b) (2) ] <br /> T TANK GAUGINGMT <br /> Tank Gaugi!12 Weekl [23CCR 2645(b) ] <br /> Annua Tank Integrity Test 23CCR 2645 <br /> PIPING MONITORINgz <br /> Daily Suction Piping Monitoring [23CCR App—III <br /> Piping Tightness Test [23CCR 2643 (b) , (c) , (d) ] <br /> rave Piping es a ever ears e <br /> Month7y Line Test L23CCH 2643 c 2 <br /> -Tairfual Leaka ec or test L23CCR app. <br /> SYSTEM STATUS: Major Violations No Violations <br /> COMMENTS: �C� riV\ <br /> REHS: RECEIVED BY <br /> TITLE: PHONE• DATE• $ Y� <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />