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6 i <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 T , Y ' (, Program ID)# + <br /> P <br /> Facility Address Cx` ]] �� k�Cit Zi <br /> Y -� CC Y ]''G� Y'{ P <br /> UST; Dual Wall Single wal OVERFILL: Audible Visual Mechanical <br /> PIPING SYSTEM: D al wall�Single wall Suction Pressure Gravity <br /> DOES THE LEAK DETECTION ,SYSTEM meet 23CCR 2636 (8) requirements? YES NO:�K: <br /> VIOLATIONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&SC 25284] <br /> Forms A & B Current H&SC 25284 c <br /> Monitoring/Maintenance Records 23CCR 2712 b <br /> Monitoring Records Available 23CCR 2712 <br /> Monitoring Plan 23CCR 2632 (d) (1) ] <br /> Response Plan_ (23CCR 2632 (d) (2) ] <br /> Unauthorized Releases Reported [H&SC 25295] <br /> Monitoring Equipment Annual Cert. 23CCR 2630 <br /> ver spill on ainer LT= 2635 �b) j <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 26301 <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Meters Calibrated r23ccg 2646 (1) 1 <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-Variation Procedure FoiiowecL [23CCR 2G46 (e) j <br /> STATISTIQU 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 Sticx Reacing c <br /> OKA IC TANK GAUGING (ATC4) <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 Fankn egri y es <br /> Iank Gaug-3—n-g-13-r-5-cedure eoiiowea <br /> PIPING MONITORING <br /> Daily Suction Piping Monitoring f2 R A . II <br /> Piping Tightness Test 23CCR 2643 b c d <br /> Gravity Pi2ing Tested Every 2 Years [23CCR 2643 (e) ] <br /> Monthly Line Test L23CCR 2643 c 2 <br /> Annual e r <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> RemoveT, Closed or Temporar y Closed 23CCR 2670 <br /> REHS j6i ! . � INSPECTION DATE/TYPE: <br /> CI / y <br /> D <br /> Refi-s d Dat�,e "7/1579 / 23 CCR UST Regs May 5, 1994 PAGE of <br /> / <br /> PHS 260 (4198) 5 � C �1 4&Y L✓ <br />