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PUBLIHEALTH SERVICES SAN J0AQUIjrC0UXTy <br />ENVIRONMENTAL HEALTH DIVISION <br />304 E. Weber Ave., Third Floor, Stockton, CA 95202 <br />(209) 468-3420 <br />1-1-URAGE TANK (DST) PROGRAM INSPECTION REPORT <br />h,y��, _ _ <br />Facility Name � 1 � ( v <br />Program ID (/�a� J <br />Facility Address City v Zi <br />UST: Dual Wall Single Wall OVERFILL: Audible Visual Mechanical <br />PIPING SYSTEM: Dual wall Single wall Suction— <br />DOES THE LEAK D8T8CTION SYSTEM meet 23CCR 2636(g) requirements? YES NO <br />VIOLATIONS <br />maaTv u <br />uaa um" SRAL R 1UIREMZNTS --- <br />Permit to Operate [H&SC 252841 <br />orms & urrent & 5 4 c <br />Monitorin Maintenance Records 23CCR 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 Annua Cert. 23CCR 2630 <br />ver s i on ainer <br />Cathodic Protection 23CCR 2635 a 2 A <br />New USTs Monitored Continuously [23CCR 26301 <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />Meters Calibrated 123CCR 2646(i)l <br />Monthly Variations Calculated 123CCR 2646(d)] <br />Ex -variation Procedure FOiiOWee <br />STATISTLQL INVENTORY–RECONCILIATION (SIR) <br />Inconclusive Procedure Followed [23CCR 2646.1(d)] <br />UST Inteqrity Test Every Two Years 23CCR 2646.1 <br />Annual SIR Report [23CCR 2646.1(j)] <br />Daily Stick Reading c <br />AUTQMATTr TANK GATTGTHQ (ATG) <br />Monthly ATG Results 123CCR 2643(b)(1)] <br />Annuai ATU Summary Report <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />Annual an n egri y lest <br />anx (3auging Proceaure Foiiowect <br />Daily Suction Piping Monitoring <br />Piping Tightness Test 23CCR 2643 b c d <br />GravitPi in Tested Ever 2 Years [23CCR 2643(e)] <br />Mont y Line Test 23CCR 2643 c 2 <br />Annuai Leak <br />TANK REMOVAL ilk <br />Permit to Close or Cease Operation H&SC 25298 <br />Remove Closed or Temporar y Closed CCR <br />REHS�/ y/T INSPECTION DATE/TYPE: 2C 417 P%,V <br />RECEIVED BY: <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br />PHS 231 (S97) <br />