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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 n _ Program ICCD# __a3 (O6 / --'�77 <br /> Facility Address 467.5 �-_. ct,//l�v Sf. city Sfoc'1 f� zip 95,-A !.5 <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) 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 25 84 c <br /> Monitoring/Maintenance Records r23CCR 2712 (b) ] <br /> Monitoring Records Available 23CCR 2712 <br /> Monitoring Plan 23CCR 2632 (d) (1) ] <br /> Response Plan F23CCR 2632 (d) (2) ] <br /> Unauthorized Releases Re orted [H&SC 252951 <br /> Monitoring Equipment AIInua Cert. 23CCR 2630 <br /> Over spill on ainer <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 26301 <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> TRAf 2941 11 1 <br /> Meters Calibrated r23CCR 4 i <br /> Gauging Stick in 1 /R Tnrhpq r2ACCR 2646 (c) (1) (Ell <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-Variation Procedure koliowea L23CUR 2646 (e) j <br /> STATISTICAL INVENTORY RECONCILIATTnW (RTRI <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 /> AUTOMATIC! TANK GAUGING (ATG) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annual ATU Summary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annual an n egri y iest L2.iUCR 2b4bUD) l <br /> ranr Gauging roce ure o owe <br /> Daily Suction Piving monitoring r2 I <br /> Piping Tightness Test 23CCR 2643 b c d <br /> Gravity Pi in Tested Ever 2 Years [23CCR 2643 (e) ] <br /> Mont y Line Test 23CCR 2643 c 2 <br /> Annual <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25296 <br /> Removea, C os" "eor Temporar y Closed 23CCR 2670 <br /> REHS ] INSPECTION DATE/TYPE: - <br /> RECEIVED BY: PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE__L_of <br /> PHS 260 (4/98) <br />