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0 0 <br /> 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 Name 1 L Program ID#11 I9 j®,5 3 a <br /> Facility Address - vo IS Qy , / City S /OGh�i4.n zip - -5 <br /> UST: Dual Wall Single Wall OVERP LL: Audible Visual Mechanical <br /> PIPINGPIPING SYSTEM: Dual wall Single wall Suction Pressure><_Gravity <br /> DOES THE LEAK DETECTION SEM meet 23CCR 2636 (g) requirements? YES>QNO <br /> VIOLATI S <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&SC 252841 <br /> Forms A & B Current H&SC 25284 c <br /> Monitoring/Maintenance Records 123CCR 2712 (b) ) <br /> Monitoring Records Available 23CCR 2712 <br /> Monitoring Plan 23CCR 2632 (d) (1) ] <br /> Response Plan r23CCR 2632 (d) (2) 1 <br /> Unauthorized Releases Reported [H&SC 25295] <br /> Monitoring Equipment Annual Cert. 23CCR 2630 <br /> Over spiii Container [23CCR 2635 (b) j <br /> Cathodic Protection 123CCR 2635 a 2 A <br /> New USTS Monitored Continuously [23CCR 26303 <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Meters Calibrated f23CCR 2646 (i) l <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-variation Proceaure ollowee) j <br /> STATISTICAL INVENTORY RECONCILIATION (SIRI <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 /> AUT TIC TANK GAUGING (ATG) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annuai AiG summary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annual an n egri y lest <br /> -7a—nk Gauging Procedure FoiioweO <br /> PIPING MONITORING <br /> Daily Suction PitAng Monitorina r23CCRI <br /> Piping Tightness Test 23CCR 2643 b c d <br /> Grayit Pi in Tested Ever 2 Years [23CCR 2643 (e) ] <br /> Mont y Line Test 23CCR 2643 c 2 <br /> Annuai <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Removed, Closed or Temporar y Closed 23CCR 2670 <br /> REHS INSPECTION DATE/TYPE: �j <br /> RECEIVED BY: PHONE:�� ��j <br /> Revised D e 7/1 /97 23 CCR UST Regs May 5, 19994PAGE_of v� <br /> PHS 260 (4/96) <br />