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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 NameoAth4-g CA/I Program �I+D# �, �q <br /> Facility Address-4161 X ( �OiY A 2n City\ j- __zip `.5a e)-5 <br /> UST: Dual Wall Single Wail OVERFILL: Audible Visual Mechanical <br /> PIPING SYSTEM: Dual wall Single wall XSuction YY Pressure Gravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (g) requirements? YES NO '>< <br /> VIOLATIONS 7� <br /> UST GENERAL REQUIREMENTS TANK # <br /> Permit to O erate [H&SC 252841 <br /> Forms A & H Current H& C 25T8747E7—cTT— <br /> intenance Records r23CCR 2712 b <br /> Monitor <br /> in Records Available 23CCR 2712 <br /> Monitorin Plan 23CCR 2632 (d) (1) <br /> Unauthorized Releases Re orted [H&SC 252951 <br /> Monitoring Equipment Annua Cert. 23CCR 2630 <br /> ver sviii Container <br /> Cathodic Protection 23CCR 2635 (a) 2 A <br /> New USTs Monitored Continuously [23CCR 26301 <br /> MANUAL INVENTORY RECONCILIATION (MIR)UST Tntparitv 111 <br /> mp , <br /> Meters Calibrated r23ccg 264flu) i <br /> Gauging Stick in 1/A Tnchpq r2lC'rR 9.64r (r) (J � (Ell <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-Variation Procedure Foiiowect L23CL:x ;4b4b (e) j <br /> STATISTICAL INVENTORY REVONCTLIATION (SIR) <br /> Inconclusive Procedure Followed [23CCR 2646.1(d) ] <br /> UST Intearitv Test Every Two Years 23CCR 2646.1 <br /> Annual SIR Report [23CCR 2646.1 (j) ] <br /> a1 y is ea ing c <br /> AUTOMATTQ TANK GAUGING (ATG) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> P.nnual ATG Summary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> �nual aanxn egri y lest <br /> ianx Uauging Proceclure o owe <br /> MonitoringPIPING MONITORING <br /> Daily Suction Piping <br /> Pi in Ti htness Test 23CCR 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 /> Remove C ose or TeErar y ose 23C R 2-9-70-T---, <br /> REHS INSPECTION DATE/TYPE: <br /> RECEIVED BY: PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGEJof <br /> PHS 260 (4/98) <br />