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0 0 <br /> PUBLIC HEALTH SERVICES SAN UOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E. Weber Ave. , Third Floor, Stockton, CA 95202 <br /> 209/466-3420 <br /> UNDERGROUND TANK PROGRAM OFFICIAL INSPECTION REPORT <br /> Facility Name ('1 - Facility ID# <br /> Facility Address 2' v e'f`111 ' + City 21P u <br /> Facility Phone # 3 i 'CV Facility Contact_ <br /> Inspection Date: y Inspection Type: it <br /> UST: Dual Wall X . Single Wall OVERFILL: Audible VisualAe_Mechanical— <br /> UST Monitoring Alternative UST Contents (/Jc�-s t-e Qi n <br /> PIPING SYSTEM: _Dual Wall Single Wall Suction Pressure_x__Gravity <br /> Does the leak detection system shut off the pump automaticallyVIdLATIONSNO_/U. <br /> TANK # <br /> UST GENERAL RE UIREMENTS <br /> Permit to operate [H&S 252841 <br /> orms Curren c L1 q7 <br /> oni or in ain enance _ecor s <br /> Financia Responsibi zty [H&S 25292.2 (a) ] <br /> monitoring 17ecordsV`a-ia le L=R 2, 112 <br /> oni orzng Plan <br /> Response Plan L23CCR 2632 2 ✓. <br /> Unaut orize Re eases Rel2orted LH&S 25295 <br /> Monitoring Equipment Annual Test L23UCR 2630 r/ <br /> over s 5-11-Container <br /> Permitted UST Repairs 23CCR 2661 <br /> Permitted Upgrades 123CCR 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 readincr 121CCR 44 c i <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 /> OTT Liiueqrity 1,estever wo ears <br /> Annual SIR Report 23CCR 2646.1 <br /> aiy L;tTcjc Reading c <br /> AUTOMATIC TANK GAUGING ATG <br /> Monthly ATG Results L3CCR 2643 (b) (1) ] <br /> Annual ATG Summary Re ort L23CCR 2712 b 2 <br /> MANUAL UST TANK GAUGING IPTG <br /> Tank Gau ing Weekly L23CCR 2645 (b) ] <br /> Annual Tank Integrity `Pest 23CCR 2645 b <br /> PIPING MONITORING <br /> Daily Suction Piping Monitorin L23CCR App—III <br /> Piping Tightness Test L23CCR 2643 (b} (c) , (d) ] <br /> -Gravityi zn este ever ears e <br /> Monthly Line Test 23CCR 2643 (c) (2) ] <br /> Tk-nnuaiea etector test pp.JV 1 <br /> SYSTEM STATUS: Major Violations No Violations <br /> COMMENTS: 4 <br /> REHS: L4Y RECEIVED BY: Q <br /> TITLE: PHONE: DATE: <br /> Revised Date 1/29/97 23 CCR UST Regs May Sr 1994 <br />