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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 -I)t 'Ir d Food Facility ID# <br /> Facility Address 2A d City `y <br /> Zip�� <br /> Facility Phone # 85 Facility Contact 44 t ,r <br /> Inspection Date: S 9 Inspection Type: Ra u-I-tn� <br /> UST: Dual WallZ Single Wall— OVERFILL: Audible ✓Visual --Mechanicaly <br /> UST Monitoring Alternative UST Contents_ M\/F <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 # � Ll <br /> UST GENERAL REQUIREMENTS UL 1 -- <br /> Permit to Operate [H&S 252841 <br /> Forms A & B Curren c ✓ <br /> Monitoring/Maintenance Records L23CCR 2712 (b) j <br /> �/7�Financial Responsibility LH&S 25292.2 (aTI <br /> oni orsng Records vai a e <br /> oni oring an ✓ <br /> esponse Plan L23CCR 2632 2 ✓ ✓ ✓ <br /> yL Unaut orize Re eases Reported H&S 25295.. <br /> Monitoring Equipment Annual Test '23CCR 2630 <br /> over spiii Container <br /> Permitted UST Repairs 23CCR 2661 <br /> Permitted Upgrades [23CCR 26601 <br /> Cathodic ro ec ion L23CUR 2635Ta_TTTFTA) J <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 rea in CCR 2446 (c)_W <br /> Gauging Stick in 1/8 inches [23CCR 2646 (c) (1) (E) l <br /> STATISTICAL INVENTORY RECONCILIATION SYR <br /> Excessive Variation Reported 23CCR 2646.1(d) <br /> usi integrity es every two years <br /> Annual SIR Report L23CCR 2646.1 J <br /> Daily ick Reading c <br /> AUTOMATIC TANK GAUGING ATG <br /> Monthly ATG Results [3CCR 2643 (b) (1) l <br /> Annual ATG Summar Re ort 23CCR 2712 b 2 <br /> MANUAL UST TANK GAUGINGMT <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annual Tank Integrity Test L23CCR 2645 (b) ] <br /> PIPING MONITORING <br /> Daily Suction Piping monitoring [23CCR App—III <br /> Piping Tightness Test [23CCR 2643 (b) , (c) , (d) ] <br /> Gravity Piping este every 2 years L23CCR 2943ke) j <br /> Monthly Line Test L23CCR 2643 c 2 <br /> -IEH—ul—al Leaketector test pp. 1 <br /> SYSTEM STATUS: Major Violations No Violations <br /> COMMENTS: _ <br /> RENS: RECEIVED BY: <br /> TITLE PHONE: DATE: <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />