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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 /> � <br /> Facility Name " �P //�yyl illi ��U Program ID##. �{�`�/�.j& / <br /> Facility Address . 3 _City �1 ('LILTUYI zip 6j`�AG6 <br /> UST: Dual Wall Single Wall " OVERFILL,.,, Audible Visual Mechanical <br /> PIPING SYSTEM: Dual wall Si g e wall A Suction PressureGravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (g) requirements. YES NO>c- <br /> VIOLATIONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to O erste [H&SC 252841 <br /> Forms A & B urrent H& 252 4 -CTT <br /> Monitoring/maintenance Records r23CCR 2712 b <br /> Financial Re_snnnsi_bil_itk (H&RC 2529 <br /> Monitoring Records Available [23CCR 2712 <br /> Monitoring Plan 23CCR 2632 (d) (1) ] <br /> Re RnnnsPlan [23CCR 63 (d) (2) 1 <br /> Unauthorized Releases Re orted [H&SC 252951 <br /> Monitoring Equipment Annus Cert. 23CCR 2630 <br /> ver spill container [23CCR 263b �b) j <br /> Permitted TTRT Remi rs [23('rR 26611 <br /> Permitted T11pnradea [2'i(`( P 266(11 <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 26301 <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Lnnnal MTA Report r?'ArrR ?r4r (g) 1 - <br /> Meters Calibrated [23CCR 2646 (i) 1 <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-variation Procedure Followed L23CUR 2b4breTT <br /> STATISTICAL INVENTORY RECONCILIATION (SIR) <br /> Inconclusive Procedure Followed [23CCR 2646.l (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 rAUGING (ATG) <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 ank integrity Iest <br /> lank Uauging Procedure oiiowed <br /> PIPING MONITORING <br /> Daily Suction Piving Monitoring r23CCR Aup. III <br /> Pining Tightness Test 23CCR 2643 b c d <br /> Gra <br /> vit Pi in Tested Ever 2 Years [23CCR 2643 (e) ] <br /> Mont y Line Test 23CCR 2643 c 2 <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> -Te-m-o`veT,7:losea or Temporar y Closed [23CCR 2670J <br /> REHS v Qi Q-, INSPECTION DATE/TYPE: <br /> RECEIVED BY: PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE—of— <br /> PHS <br /> AGEofPHS 260 (V90) <br />