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PUBLI41HEALTH 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,)(t Program ID#_ `-)Ci,S,���r� 7 <br /> Facility Address / L4 b wIV 17,e, - ' -City Zip <br /> UST: Dual Wall _jingle _Wall ' OVERFILL: Audible Visu 1 Mechanical <br /> PIPING SYSTEM: Dual wall -"< Single wall Suction Pressure Gravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (g) requirements?? YES NO— <br /> VIOLATIONS <br /> UST GENERAL REQUIREMENTS TANK <br /> Permit to Operate [H&SC 252841 <br /> Forms A & B Current [H&SC 252 4 c <br /> Monitorin Maintenance Records r23CCR 2712 b <br /> Monitoring Records Available r23CCR 2712 <br /> Monitorinq Plan 123CCR 2632 (d) (1) <br /> Response Plan r23CCR 2,612 (d) 12) 1 <br /> Unauthorized Releases Rep <br /> eorted [H&SC 252951 <br /> Monitoring Equipmnt Annua Cert. 23CCR 26-3oTdTj <br /> Over spiii Uontainer <br /> Cathodic Protection 23CCR 2635 (!1,, _ ,2 A <br /> New USTs Monitored Continuously [23CCR 2 630 <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Meters Calibrated R <br /> Gauaina Stick in 1 /A Inches r23CCR 2646 (r) (1 ) (F) l <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-variation Procedure Foiiowea L23CUR ;e(34677r <br /> STATISTICAL INVENTORY RECONCILIATION (SIR) <br /> Inconclusive Procedure Followed [232CR 2646.1 (d) ] <br /> UST Integrity Test Every Two Year 23CCR 2646.1 <br /> Annual SIR Report [23CCR 2646.1 (j) ] <br /> ai y z6uluk Reading c <br /> AUTO TIC TANK GAUGING (ATQ) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annual Summary Report <br /> MANUAL UST TANR GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> P.nnuai ianxn egri y lest <br /> Uanx Uauging—Proceaure__FoIiowed <br /> PIPING MONITORING <br /> Daily i n Piping monitoring r23CCR App._111 <br /> Piping Tightness Test r23CCR 2643 b c d <br /> Gravit Pi in Tested Ever 2 Years [23CCR 2643 (e) ] <br /> Month y Line Test 23CCR 2643 c 2 <br /> Annual <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Removed, C ose or Temporar y Closed 23CCR 2670 <br /> REHS-,j „ �,� INSPECTION DATE/TYPE: <br /> T N l ��K -767 <br /> RECEIVED BY: PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br /> PHS 231(9/97) <br />