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w4w w <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 C Fac i ity ID# <br /> Facility Address J CityZip 5 <br /> Facility Phone # FFacility Contact C <br /> Inspection Date: - Inspection Type: in <br /> UST: Dual Wall Single Wall OVERFILL: Audible_ Visual Mechanical <br /> UST Monitoring ternative C9&41dZUST 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 /> VIOLA IONS <br /> TANK # <br /> UST GENERAL REOIIIREMENT3 <br /> Permit to Operate [H&S 252841 /Arov F ' <br /> Forms A & S curren c <br /> one orin a—in enance Records <br /> Financial Responsibility (H&S 25292.2 a <br /> Monitoring Records Availaole <br /> Monitoring Plan <br /> Response Plan 23CCR 2632 (d) (2) ] <br /> UnautftorizecL Releases Reported [H&S <br /> Monitoring Equipment Annual Test L23CCR 2630 <br /> ver spill on ainer <br /> Permitted UST Repairs 23CCR 2661 <br /> Permitted Upgrades [23CCR 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 tic readinq t23CCR 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 /> Ubr Integrity ea every two years <br /> Annual SIR Report L23CCR 2646.1 <br /> Daily SticK xeading c <br /> AUTOMATIC TANK GAUGING ATG <br /> Monthl ATG Results [3CCR 2643 (b) (1) ] <br /> Annua ATG Summary Report L23CCR 2712 (b) (2) ] <br /> MANUAL UST TANK GAUGING <br /> Tank Gau in Weekl [23CCR 2645 (b) ] <br /> Annua Tan Integrity Test 23CCR 2645 <br /> PIPING MONITORING <br /> Daily Suction Piping Monitoring [23CCR A .II] <br /> Piping Tightness Test [23CCR 2643 (b) , (c) , (d) ] <br /> Gravity i in es a every 2 years e <br /> Monthly Line Test L23CCR 2643 c 2 <br /> Annual eak Detector test L23UCR App.lVtl) (a) J <br /> SYSTEM STATUS: Major Violations No Violations <br /> COMMENTS: <br /> REHS: . RECEIVED BYe `' G...-i��"64 "F' q <br /> TITLE /u� r: . /\ (.' .�. PHONE: 7 / r7 .l�o DATE: <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />