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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 STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br /> Facility Name t4AI-1- X.�rogram ID# IZZ <br /> Facility Address S Z.�l rf,�)j � City .S Zip <br /> UST: Dual Wall Singlk Wail OVERFILL: Audible Visual echanical <br /> PIPING SYSTEM: Dual wall_k,' Single wall Suction Pressure_j,,"'Grav y <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (8) requirements? YES 1i NO <br /> VIOLATIONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&SC 252841 <br /> Forms A & B Current H&SC 25284 c <br /> Monitoring/Maintenance Records 23CCR 2712 b <br /> Monitoring Records Available 23CCR 2712 <br /> Monitoring Plan [23CCR 2632 (d) (1) ] <br /> Response Plan r23CCR 2632 (d) (2) 1 <br /> Unauthorized Releases Reported [H&SC 25295] <br /> Monitoring Equipment Annual Cert. 23CCR 2630 <br /> Over spill on ainer <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 26301 <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> meters alibrated r23CCR 2 4 i <br /> Gaucrincr Stick in 1�8 Inches r23CCR 2646 (c) (1) (E) <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> EX-Variation Procedure Followect L2-iC(:R 2646 (e) <br /> STATISTICAL INVENTORY RECONCILIATION (SIR) <br /> Inconclusive Procedure Followed [23CCR 2646.1 (d) ] <br /> UST Integrity Test Every Two Years 23CCR 2646.1 <br /> Annual SIR Report [23CCR 2646 .1 (j) ] <br /> ai y SticK Reacting c <br /> AUT014ATIC TANK GAUGING (ATG) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annual Summary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annual lankn egri y lest <br /> lank Gauging Procedure Foliowea <br /> PIPING MONITORING <br /> Daily Suction Piping Monitoring r23 CR Avy.II1 <br /> Piping Tightness Test 23CCR 2643 b c d <br /> Gravity Piping Tested Every 2 Years [23CCR 2643 (e) ] <br /> Monthly Line Test L23CCR 2643 c 2 <br /> Annual e <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Removed, Ciosed or Temporar y Closed 23CCR 2670 <br /> REHS NSPECTION DATE/TYPE: - <br /> r <br /> RECEIVED BY: PHONE:��/� <br /> Revised Date 7/15/97 / 23 C R UST Regs May 5, PAGE_]__of Z,- <br /> PHS 231(9/97) <br />