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0 • <br /> 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 /4. �f� f� Facility ID# p <br /> Facility Address <br /> 0— City <br /> Zip <br /> Facility Phone # Facility Contact <br /> Inspection Date: I i— �spection Type: <br /> UST: Dual Wall_ ngle W _ OVVERFILL: Audible_ Vis al_Mechanical_ <br /> UST Monitoring Alternative UST Conitents <br /> PIPING SYSTEM: Dual Wall_Single Wall ✓Suction Pressure Gravity <br /> Does the leak detection system shut off the pump automatically? YES_ NOS <br /> VIOLATIONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&S 252841 <br /> orms A & 6 current c <br /> on: or in ain enance Records 1 <br /> Financia Responsibi ity H&S 25292.2 (a) ] <br /> monitoring Recoras Availazle L.�Juux 2 /12J <br /> monitoring Pian <br /> Response Plan 23CCR 2632 (d) (2) ] <br /> unautnorizea Re eases Reported H&S 25295J <br /> Monitoring Equipment Annuai Test L23CCR 2630 <br /> ver spiii Container <br /> Permitted UST Repairs 23CCR 2661 <br /> Permitted Upgrades [23CCR 2660] <br /> Catliodic Protection 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 /> Dailv Stickrea 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 23CCR 2646.1 (d) <br /> US <br /> Integrity ea every wo ears <br /> AnnualSIR Report 23CCR 2646.1 7 <br /> Daily 6cick Reacting c <br /> AUTOMATIC TANK GAUGING ATG <br /> Monthl ATG Results 13CCR 2643 (b) (1) ] <br /> Annua ATG Summar Report 23CCR 2712 b 2 <br /> MANUAL UST-TANK A 2 MT <br /> Tank Gau in Weekl [23CCR 2645 (b) I <br /> Annua Tan 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 Piping este every 2 years [23CCR 2977 e <br /> Monthly Line Test L23CCR 2643 c 2 <br /> Annuai LeakDetector test L23CCR App.lV(1) (d) j <br /> SYSTEM STATUS: Major Violations / No Violations <br /> COMMENTS• S c-C— ➢1� - <br /> REHS: RECEIVED 'S (YL- <br /> TITLE: / �E'/H G1'L�. PHONE: `f(P(p "/'iY" (/ DATE: <br /> Revised Date 1/29/97 23 CCR i7ST Regs May 5, 1994 <br />