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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 i -- Facility ID# 17 3'a <br /> Facility Address 1246t, -i-'' City zip <br /> Facility Phone # 33 Facility Contact <br /> Inspection Date: A-� , Inspection Type: <br /> UST: Dual Wall Single Wall_K OVERFILL: Audible Visual Mechanical_ <br /> UST Monitoring Alternative° UST Contents , <br /> PIPING SYSTEM: Dual Wall Siifgle Wall Suction Pressure Gravity <br /> Does the leak detection system shut off the pump automatically? YES_ NO_ <br /> VIOLATIONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&S 252841 <br /> Forms A & B current c <br /> Monitoring/Maintenance Records L23CCR 2712 (b) ] <br /> Financial Responsibility LH&S 25292.2 (a) ] <br /> monitoring Records AvailaDle L23CUR 27121 <br /> Monitoring Plan <br /> Response Plan L23CCR 2632 2 <br /> Unaut orize Releases Reported H&S 25295 <br /> Monitoring Equipment Annual Test L23CCR 2630 <br /> ver spill on ainer <br /> Permitted UST Repairs 23CCR 2661 <br /> Permitted Upgrades [23CCR 26601 <br /> Cathodic ro ec ion L23CCR 2b3b ta) <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 Stickreadincr L23CCR 446 c 1 <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 /> USr integrity es every two years L2JCCR 2b4b.1 tg) j <br /> Annua SIR Report L23CCR 2646.1 <br /> Daily Sticic ReacLing c <br /> AUTOMATIC TANK GAUGING ATG <br /> Monthly ATG Results [3CCR 2643 (b) (1) ] <br /> Annual ATG Summary Report L23CCR 2712 b 2 <br /> MANUAL UST TANK GAUGINGT <br /> Tank Gauging Weekly [23CCR 2645(b) ] <br /> Annual Tank Integrity Test L23CCR 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 e <br /> Monthly Line Test L23CCR 2643 c 2 <br /> Annual ea etec or test L23CCR App.lV(1) (d) j <br /> SYSTEM STATUS: Major Violations No Violations <br /> COMMENTS: <br /> RENSc �:�4 RECEIVED/ BY: n <br /> TITLE: f i�n j 1q'f- 2*,01-11PHONE: 1-20 9) 7t "�3L DATE: 10,40'4 <br /> Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />