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PUBLIC HEALTH SERVICES SAN JOA+QUIN 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# <br /> Facility Address City zip <br /> UST: Dual Nall Single Wall OVERFILL: Audible Visual Mechanical <br /> PIPING SYSTEM: Dual wall Single wall Suction Pressure Gravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (8) requirements. YES NO <br /> VIOLATIONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&SC 252841 <br /> Forms A & B Current H&SC 25284 e <br /> Monitoring/Maintenance Records F23CCR 2712 (b) ] <br /> monitoring Records Available 23CCR 2712 <br /> Monitoring Flan [23CCR 2632 (4) (1) ] <br /> Unauthorized Releases Reported [H&SC 25295] <br /> Monitoring Equipment Annual Cert. 23CCR 2630 <br /> ver spill on ainer <br /> Parmittptj UST Rppairs [23CCR 266j1 <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 26301 <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Meters ibra d r23CCR 2 4 i <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> x- aria ion Procedure Foiiowee) j <br /> ST&TISTICAL INVENTORX RECONCILIATION (61R) <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 /> ai y Stick Reading c <br /> AUIQMATTr. TANK GAUGINQ (ATV-) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annuai ATG Summary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> nual I'ank integrity Test <br /> 'rank Gauging Pro3edure o owe <br /> Daily Suction Piping Monitoring 2 CR Alpy.III <br /> Piping Tightness Test 23CCR 2643 b c d <br /> Gravity Piping Tested Ever 2 Years [23CCR 2643 (e) ] <br /> Monthly Line Test L23CCR 2643 c 2 <br /> Annual eaX jetEctor IesL <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Removed, Closed or Temporar y Closed 23CCR 26701 L <br /> REHS INSPECTION DATE/TYPE: <br /> RECEIVED BY: PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br /> PHS 231(9197) <br />