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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 hill P411 Ou (" Facility ID# C. ' <br /> Facility Address .i 72. i —} A 4_City zip j f <br /> Facility Phone # Facility Contact r <br /> Inspection Date:-3 - 1R1- Inspection Type: <br /> UST: Dual Wall_ Single Wall OVERFILL: Audible_ ViSA-atlLA� echanical_ <br /> UST Monitoring Alternative 1-3 ST C ntents <br /> PIPING SYSTEM: Dual Wall ng gal Suction Pressure Gravity <br /> Does the leak detection system shut off the pump automatically? YES_ N0 ` <br /> VIOLATIONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&S 252841 <br /> Forms A & B curren c <br /> onitorin ain enance Records 1 <br /> Financial Responsibility [H&S 25292.2 (a) ] <br /> monitoring Records AvaiialDie <br /> Monitoring Plan <br /> Response Plan 23CCR 2632 (d) (2) ] <br /> Unauthorized Releases Reported H&S 25295 <br /> Monitoring Equipment Annual Test 23CCR 2630 <br /> Over spill 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 23CCR 2446 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 /> 071 integrity es every two years g <br /> Annual SIR Report L23CCR 2646.1 <br /> ai y Stick Reading L23CUR 2b4b kC) <br /> AUTOMATIC TANK GAUGING ATG <br /> Monthly ATG Results [3CCR 2643 (b) (1) ] <br /> Annual ATG Summar Report 23CCR 2712 (b2 <br /> MANUAL UST TANK GAUGIN MTG <br /> Tank Gauging Weekl [23CCR 2645 (b) ] <br /> Annual Tank 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 R 2643 (e) ] <br /> Monthly Line Test 23CCR 2643 c 2 <br /> Annual ea etector test R App.l 1 <br /> SYSTEM STATUS: Major Violations No Violations <br /> COMMENTS: LC <br /> REHS: 'GJ r I C RECEIVED BY: <br /> TITLE: PHONE: DATE: 7 <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />