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0 0 <br /> PUBLIC HEALTHVI JOAQUIN COUNTY <br /> HEALTHENVIRONMENTAL TSI <br /> 304 E. Weber Ave. , Third Floor, Stockton, CA 95202 -- <br /> 209/468-3420 <br /> UNDERGROUND TANK PROGRAM OFFICIAL INSPECTION REPORT <br /> Facility Name(,/ Facility ID# <br /> Facility Address �, txllklcon Ci i i i Zip <br /> Facility Phone # Facility Contact <br /> Inspection Date: Inspection Type: <br /> UST: Dual Wall_ Singe 11-7X OVERFILL: Audible_ Vis al®Mechanical <br /> UST Monitoring Alternative UST Contents "(he v <br /> PIPING SYSTEM: Dual Wall Single Wall Suction Pressure Giavity <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 K & S curren c <br /> ons ore ance Records <br /> Financial Responsibility [H&S 25292.2(a) ] <br /> Monitoring Recofds Availaole <br /> one orin an <br /> Response Plan 23CCR 2632 2 <br /> Unautnorized Releases Reported LH&S5 <br /> Monitoring Equipment Annual Test L23CCR 2630 <br /> ver s i on ainer <br /> Permitted UST a airs 23CCR 2661 <br /> Permitted Upgrades [23CCR 26601 <br /> a o is ro ec ion a <br /> MANUAL INVENTORY ECO CILIATION I <br /> UST Inte rit Test [23CCR 2643.11 <br /> Annual MIR Re ort 23CCR 2646 <br /> Meters Calibrated [23CCR 2646 (e) (4)] <br /> ai tic rea in 44 c <br /> Gauging Stick in 1/8 inches [23CCR 2646 (c) (1) (E)] <br /> STATISTICAL INVENTORY RECONCILIATION JSIRJ <br /> Excessive Variation Reported 23CCR 2646.1 d) <br /> UST-T-nt-earlty Testevery two years [23CCR 2b4b.1 <br /> Annual SIR Report L23CCR 2646.1 <br /> ai y Su"K ReaZllffg- c <br /> AUT014ATIC TANK GAUGING ATG <br /> Monthly ATG Results [3CCR 2643 (b) (1)] <br /> Annua ATG Summary Report I23CCR 2712 (b) (2) ] <br /> L UST TANK GAUGING (XJg) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annual Tiahk Integrity Test 23CCR 26451W] <br /> PIPINg MONITORING <br /> Daily Suction PiDina Monitoring [23CCR APP.III <br /> Piping Tightness Test [23CCR 2643 (b) , (c) , (d) ] <br /> rave in es a ever ears e <br /> Mont y Line Test L23CCR 2643 c 2 <br /> nua ea a ec or es pp. <br /> I <br /> SYSTEM S TUS: Major Violate ns N6 Violations <br /> COMMENTS: <br /> REHS: 6 RECEIVED Y: gg <br /> TITLE: R, PHONE: t DATE: <br /> Revised Date 1/29/97 - 23 CCR UST Regs May 5, 1994 <br />