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J <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 (oQZ57n H.ia n Ci Facility ID# Ib <br /> Facility Address 250 _ omae }N1L� City w r � zip <br /> Facility Phone # Facility Contact <br /> Inspection Date : Inspection Type : Q,�npyo4. <br /> UST : Dual Wall_ ginjle Waller 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 REQIIIREMENTS <br />- . Permit to Operate (H&S 252841 <br /> orms A & B curren c <br /> Monitoring/ Maintenance Recors12 ( b ) j <br /> 'Financial Responsibility LH&S 25292 . 2 ( a ) ] <br /> monitoring xecoras AvailaiDle <br /> Monitoring Pan <br /> Response Plan 23CCR 2632 2 <br /> "TH'authorized Releases Reported H&S 25295 <br /> Monitoring Equipment Annual Test L23CCR 2630 <br /> over spill on ainer <br /> Permitted UST Repairs [ 23CCR 2661 <br /> Permitted Upgrades [ 23CCR 26601 <br /> Uattiodic 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 /> Daily Stick rea in [ 23CCR 2446 c 1 <br /> Gauging Stick in 1 / 8 inches ( 23CCR 2646 ( c ) ( 1 ) ( E ) ] <br /> STATISTICAL INVENTORY RECONCILIATION SIR <br /> y Excessive Variation Reported [ 23CCR 2646 . 1 ( d ) <br /> fl4USI integrityes every two years g <br /> Annual SIR Report L23CCR 2646 . 1 7 <br /> Daily sticK Reaaing c <br /> AUTOMATIC TANK GAUGING ATG <br /> Montha <br /> l ATG Results [ 3CCR 2643 ( b ) ( 1 ) ] <br /> ua <br /> AnnATG Summry Report L23CCR 2712 b 2 <br /> MANUAL IIT TANK GAUGI G MTG <br /> Tank Gau in Weekl [ 23CCR 2645 ( b ) ] <br /> Annual Ta Integrity Test 23CCR 2645 b <br /> PIPING MONITORING <br /> Daily Suction Piping Monitoring [ 23CCR A . II ] <br /> Piping Tightness Test ( 23CCR 2643 ( b ) , ( c ) , ( d ) ] <br /> Gravity i inq 1:estea every 2 years L23CCR 2643 ( e <br /> Monthly Line Test t23CCR 2643 c 2 <br /> Annual ea etector test R pp . 1 1 <br /> SYSTEM STATUS : Major Violations No Violations <br /> COMMENTS * <br /> REHS : RECEIVED BY : <br /> TITLE : PHONE : DATE : <br /> Revised Date 1 ; 29 / 97 23 CCR UST Regs May 5 , 1994 <br />