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PUBLI'&'HEALTH SERVICES SAN JOAQUIeCOUNTY <br />ENVIRONMENTAL HEALTH DIVISION <br />304 E. Weber Ave., Third Floor, Stockton, CA 95202 <br />(209) 468-3420 <br />Facility <br />Facility Address <br />UST: Dual Wall Singl <br />PIPING SYSTEM: Dual wal <br />DOHS THE LEAK DETECTION <br />STORAGE <br />nTANK <br />(�(`Uy�ST})) PROGRAM INSPECTION REPORT <br />[-'fill,) y Program ID# <br />\1 <br />"rP' Q,(} City Y_h'-A <br />OVERFILL: Audible Visual Mechanical <br />gle wall Suction�Pressure Gravity <br />meet 23CC 636(g) requirements? YES NO <br />VIOLATIONS <br />i wivrt R <br />UST GENERAL R8 UIREMBNTS <br />Permit to ;rate [H&SC 25284] <br />B <br />Forms A & urrent LH&SC 25284(ST7CTT <br />Monitoring/Maintenance Records r23CCR 2712 b <br />Financial ReRpnngihility rHfc;C' 21;292.2(A)1 <br />Monitoring Records Available 23CCR 2712 <br />Monitoring Plan 23CCR 2632 d (1 <br />Response Plan f23CCR 2632(d)(2)1 <br />Unauthorized Releases Re orted [H&SC 25295] <br />Monitoring Equipment Annua Cert. L23CCR 2630 <br />over spiii Uontainer <br />Permitted UST Repairs [21CCR 26611 <br />Cathodic Protection f23CCR 2635 a 2 A <br />New USTS Monitored Continuously [23CCR 26301 <br />MANUAL INVENTORY RECONCILIATION (MIR) ' <br />o Ve <br />Meters Calibrated r23CCR 2646(i)l <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -Variation Procedure Foliowee)j <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 Reacling c <br />TANK GAUGING (ATG) <br />-A=OMATIC <br />Monthly ATG Results 123CCR 2643(b)(1)] <br />Annuai ATG summary Report <br />MANUAL QST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />Annuai Tankn egri y lest <br />ranx uaugingroc; ure 1--ollowea <br />PIPING MONITORING <br />Daily Suction Pilping monitoring <br />Piping Tightness Test 23CCR 2643 b c d <br />Gvit 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 23CCR 2670 j <br />REHS ke tl 71 (ti 6 r 1 4 C1 S INSPECTION DATE/TYPE: <br />RECEIVED BY: PHONE: <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE <br />PHS 231 (9/97) <br />