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v <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 STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility Name RC' 6 g4ti /e r Program ID# <br />Facility Address City J)n Zip -s <br />UST: Dual Wall Single Wall OVERFIL • Audible Visual Mechanical <br />PIPING SYSTEM: Dual wall Sing e wall Suctionure Gravity <br />_��TiPress <br />DOES THE LEAK DETECTION SYSTBN meet 23C�636(g) fequirements? YES NO <br />� <br />VIOLATIONS <br />UST GENERAL REQUIREMENTS <br />Permit to Operate [H&SC 252841 <br />Forms A& B urrent [H&SC 25284(b)(c)] <br />monitoring/Maintenance Records r23CCR 2712 b <br />Monitorin Records Available 23CCR 2712 <br />Monitorin Plan 23CCR 2632(d)(1)] <br />Unauthorized Releases Re orted [H&SC 25295] <br />Monitoring Equipment Annus Cert. 23CCR 2630 <br />Over spill on ainer [23CCR 2635kb)j <br />Cathodic Protection 23CCR 2635(a) 2 A <br />New USTS Monitored Continuously [23CCR 26301 <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />railaina Stick in 1/8 Inches r2l= 294f;(01(l)(R)l <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -variation Procedure Followee-T7— <br />TATISTICAL <br />Inconclusive Procedure Followed [23CCR 2646.1(d)] <br />UST Integrity Test Ever Two Year. <br />23CCR 2646.1 <br />Annual SIR Report [23CCR 2646.1(j)] <br />ai y is ea ing c <br />AUTOMATIC TANK GAUGING (ATQ) <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />Annual ummary Report <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />Annual ank integrity lest <br />ranx uaugingroce ure 17)Tlowecl <br />Daily Suction Piping I <br />Piping Tightness Test r23CCR 2643 b c d <br />Grayit Pi in Tested Ever 2 Years '23CCR2643(e)] <br />Mont y Line Test 23CCR 2643 c 2 <br />TANK REMOVAL <br />Permit to Close or Cease Operation H&SC 25298 <br />Removed, Closed or Temporar y Closed 23 CR 2 70 <br />RENS INSPECTION DATE/TYPE: CU <br />RECEIVED BY: PHONE: <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE_L_of 2� <br />PHS 280 (4/98) <br />loez <br />