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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 , , , r� `'�=fir' `T��-�`' Facility ID# <br /> Facility Address --5ur City �.3i zip �' I✓ <br /> Facility Phone # Facility Contact <br /> Inspection Date:_ � �j7 Inspection 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 T <br /> Permit to Operate [H&S 252841 FX <br /> Forms A & b curren c <br /> Monitoring/Maintenance Records L23CCR 2712 �b) j <br /> Financial Responsibility [H&S 25292.2 a <br /> Monitoring Records Available 1;23CCR 2112J <br /> Monitoring Plan <br /> Response Pian L23CCR 2632 (d) (2) ] <br /> Unauthorized Releases Reported H&S 5295 <br /> Monitoring Equipment Annual Test 23CCR 2630 <br /> ver s i on ainer <br /> Permitted UST Repairs 23CCR 2661 <br /> Permitted Upgrades [23CCR 26601 <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 CR2446 (c) (1JJ <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 /> UST Integrity es every two years L2 CUR 264b.1 �9) j <br /> Annual SIR Report L23CCR 2646.1 (j) ] <br /> ai y SticK Reaaing c <br /> AUTOMATIC TANK GAUGING ATG <br /> Monthly ATG Results [3CCR 2643 (b) (1) ] <br /> Annual ATG Summary Report L23CCR 2712 b 2 <br /> MANUAL UST TANK GAUGING MT <br /> Tank Gauging Weekl [23CCR 2645 (b) ] <br /> Annual Tank Integrity Test L23CCR 2645 <br /> PIPING MONITORIN <br /> Daily Suction Piping Monitoring [23CCR a2p. III <br /> Piping Tightness Test [23CCR 2643 (b) , (c) , (d) ] <br /> Gravity Piping este every 2 years 4 e <br /> Monthly Line Test 23CCR 2643 c 2 <br /> Annual ea etector test L23CCR App. l 1 <br /> SYSTEM STATUS: Major Violations X No Violations <br /> COMMENTS: SGS- P''Cf- —rzc,,t, <br /> REHS: �I[�.� i/f14- RECEIVED BY: <br /> TITLE: PHONE: DATE: <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />