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0 <br />PUBLIC HEALTH SERVICES SAN <br />ENVIRONMENTAL <br />Weber304 E. Ave., Third Floor, <br />209/468-3420 <br />JOAQUIN COUNTY <br />DIVISION <br />Stockton, CA 0; <br />Facility Namet, G4o.,%4J Facility ID# '2-72y2E -A <br />Facility Addresses '7 F_ City Zip <br />Facility Phone # _ Facility Contact <br />Inspection Date: p Inspection Type: <br />UST: Dual Wall -SL a Wall_ OVERFILL: Audible_'Visual ®Mechanical <br />_ <br />UST Monitoring Alternative S_UST Contents <br />PIPING SYSTEM: Dual Wall Single Wall Suction j Pressure Gravity <br />Does the leak de ection system shut off the pump automa scally? YES® NO <br />VIOLATIONS <br />-AAmr, fF <br />UST GENERAL REQUIREMENTS r <br />Permit to Operate [H&S 25284] <br />Forms A & B current c <br />Monitoring/Maintenance Records <br />Financial Responsibility [H&S 25292.2(a)] <br />Monitoring Rgdords vasa e [23CCR 2-712j <br />Monitoring P an <br />Response Plan L23CCR 2632(d)(2)] <br />Unauthorized a eases Reported [H&S 2 2951 <br />Monitoring Equipment Annual Test 23CCR 2630 <br />ver s i on ainer [23CCR 2635(b)j <br />Permitted UST Re airs L23CCR 2661 <br />Permitted Upgrades [23CCR 26601 <br />Cathodic ro ec ion a <br />MANUAL INVENTORY RECONCILIATION MIR <br />UST Inte rit Test [23CCR 2643.11 <br />Annual MIRa ort 23CCR 2646 <br />Meters Calibrated [23CCR 2646(e)(4)] <br />Daily tic rea in 44 c 1 <br />Gauging Stick in 1/8 inches [23CCR 2646(c)(1)(E)] <br />STATISTICAL INVENTORY RECONCILIATION LURI <br />Excessive Variation Reported 23CCR 2646.1(d)] <br />UST Integfity Te5tevery two years <br />Annual SIR Report L23CCR 2646.1 <br />Dally StICK Reaulng c <br />AUTOMATIC TANK GAUGING ATG <br />Monthlx ATG Results [3CCR 2643(b)(1)] <br />Annual ATG Summary Report L23CCR 2712(b)(2)] <br />Tank Gauging Weekly [23CCR 2645(b)] <br />Annual Tank Integrity Test L23CCR 2645 <br />PIPINg MQKJTQRIKg <br />Daily Suction Piping Monitoring [23CCR A]2.II] <br />Piping Tightness Test [23CCR 2643(b),(c),(d)] <br />Gravity : an es ad every 2 years e <br />Month y Line Test 23CCR 2643 c 2 <br />Annual ea a ec or es pp. <br />SYSTEM STATUS: Major Violations No Violations <br />COMMENTS: E <br />RECEIVED BY: <br />TITLE: PHONE: DATE: <br />Revised Date 1/29/97 23 CCR UST Regs May 5, 1994 <br />