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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 (� Program ID# :�-5 J <br /> Facility Address <� CZ C'' City 4o /f�7Jy, zip a c- -lot <br /> UST: Dual Wall Single Wall OVERFILL: Audible Visual Mechanical <br /> PIPING SYSTEM: Dual wall Single wall-KSuction Pressure Gravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (g) �irements? YES NO:><,— <br /> VIOLATIONS <br /> UST GENERAL R8UIREMENTS TANK # <br /> Permit to O erate [H&SC 252841 <br /> Forms A & B Curren LH&SU 25284 c <br /> Monitorin Maintenance Records 23CCR 2712 b <br /> Mon <br /> itorin Records Available 23CCR 2712 <br /> Monitorin Plan 23CCR 6632 (a) (1) ] <br /> Unauthorized Releases Reported [H&SC 25295] <br /> Monitoring Equipment Annua Cert. 23CCR 2630 <br /> ver s i ( ontai <br /> Permit R�p <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTS Monitored Continuously [23CCR 26301 —_ <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> . AnDuAl MTP Pppn�t j? <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex--11-0- r0ce ure t0l'Owea L e <br /> Inconclusive Procedure Followed [23CCR 2646.1 (d) ] <br /> UST Inte rit Test Ever Two Years 23CCR 2646.1 <br /> Annual SIR Report 123CCR 2646.1 (3) 1 <br /> ai y is ea ing c <br /> 11 <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annualummary epor <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> �Uluul Iankn egri y es <br /> lank uauging roce ure o owe <br /> PIPING MONTTQRTN. <br /> n ipinct Monitoring 12 II <br /> Pi in Tightness Test 23CCR 2643 b c d <br /> Gravity Piping Tested Every 2 Years [23CCR 2643 (e) ] <br /> Monthly Line Test 23CCR 2643 c 2 <br /> Annual LEAK oecectors <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Remove C ose or Temporar y C-LoseQ L23CCR 2670 <br /> REHS INSPECTION DATE/TYPE: - <br /> RECEIVED BY: 11 PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE <br /> PHS 260 (4/98) <br />