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t w <br /> ,, <br /> . � PUBLI HEALTH SERVICES SAN JOAQUIN COUNTY <br /> 4, ENVIRONMENTAL HEALTH DIVISION <br /> 304 E. Weber Ave. , Third Floor, Stockton, CA 95202 <br /> f� (209) 468-3420 <br /> `/+ UNDERGROUND STORAG TANK (UST) PROGRAM INSPECTION REPORT <br /> Facility Name ! � Program ID# <br /> Facility AddressCity Zip <br /> VST: Dual Wail gingle Wall OVERFILL: Audible Visual Mechanical <br /> PIPING SYSTEM: ua1 wall_�C Single wall Suction Pressure Gravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (g) requirements? YES Y NO <br /> VIOLA ONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&SC 252841 <br /> Forms A & B Current Ltj&Su 25284 c <br /> Monitor in Maintenance Records r23CCR 2712 b <br /> Monitoring Records Available 23CCR 2712 <br /> Monitoring Plan [23CCR 2632 (d) (1) ] <br /> Responge Plan 123C-r-R 2632 (d) (2) 1 <br /> Unauthorized Releases Reported [H&SC 252951 <br /> Monitoring Equipment Annual Cert. ICCR 2630 <br /> Over spiii Container <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 26301 <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Meters Calibrated2 4 <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-variation Procedure Foliowed L23CCR 2b4b (e) ] <br /> STATISTICAL INVENTORY RErONCTLIATION (51R) <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 /> az y Stick Reading c <br /> AUTOMATTr- TANK GAUGING (AMC) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annual ummary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annual an n egrz y lest <br /> Tank Gauging Proceaure o owe <br /> Daily SuctiQn Pipirici Monitoring r23 R AiDip-111 <br /> Pilping Tightness Test 23CCR 2643 b c d <br /> Gravity Piping Tested Every 2 Years [23CCR 2643 (e) ) <br /> Monthly Line Test L23CCR 2643 c 2 <br /> Annaal ea e <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Removed, Closeor Temporar y Closed 23CCR 2670 <br /> REH INSPECTION DATE/TYPE: ,"� �' a b <br /> RECEIVED BY: i 7'4, PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE_I_Tof� <br /> PHS 231(9197) <br />