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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 1STORAGE TANK ��(U""ST) PROGRAM INSPECTION REPORT <br />Facility Name 1"(), SLL< ' " —(,— G Program ID# <br />Facility Address j'{ 70 j V -N aY City <br />UST: Dual Wall Single Wa11,OVERFILL: Audib] <br />PIPING SYSTEM: Dual wall Single wall Suctic <br />DOHS THE LEAK DETECTION SYSTEM meet 23CCR 2636(8) <br />Pressure Gravity! <br />requirements? YES NO // <br />VIOLATION3 <br />+M+Yn N <br />UST GENERAL REQUIREMENTS <br />Permit to O erate [H&SC 252841 <br />Forms A& B urrent LH&SC 25284 c <br />Monitoring/Maintenance Records rQ3CCR 2712 b <br />Monitoring Records Available 23CCR 2712 <br />Monitoring Plan 23CCR 2632(d)(1) <br />Unauthorized Releases Re orted [H&SC 252951 <br />Monitoring Equipment Annua Cert. L23CCR 2630 <br />ver spill on ainer Muux 2635;F7 <br />Cathodic Protection 123CCR 2635 a 2 A <br />New USTS Monitored Continuously [23CCR 2630] <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />Meters Calibrated r23CCR 2646(i)l <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -Variation ProcecLure Followed L:a3U(:R 2646(e)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 />Daily Stick Reading c <br />-=OMATIC TANK GAUGING fATG) <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 an n egri y rest <br />-IanK Gaugingroce ure I-ollowect <br />PTPTNa MONITORING <br />Daily suction Piping monitoring r23CCR App.II1 <br />Piping Tightness Test r23CCR 2643 b c d <br />Gravit Pi in Tested Ever 2 Years [23CCR-2643 (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 ose r Temp rar y Closed E23CCR 2 70 <br />REHS % (n,f-yvk.✓ INSPECTION DATE/ TYPE:_ AL7—x— <br />RECEIVED BY: PHONE: <br />PHONE: <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE—Z—of 7/ <br />PHS 260 (6/98) <br />