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0 • <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 /> F cility Name R C, �. I Program ID# 312 2 6 <br /> fa co r-,.q- I //�� �y <br /> Facility Address ' P'1 city Zip <br /> UST: Dual Wall i g e all OVERFILL: Audible Visusue ' <br /> Mechanical <br /> PIPING SYSTEM: al wall Single wall_Suction Pres _ Gravity <br /> DOHS THE LEAK DHTECTION Y TEM 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 LH&SC 25284 c <br /> Monitoring/maintenance Records r23CCR 2712 b <br /> Financial Responsibility rH&Sr 2q9.92-2 (a) l <br /> Monitoring Records Available 23CCR 2712 <br /> Monitoring Plan [23CCR 2632 d 1) <br /> Resnonse Plan [23CCR 2632 (d) (2) 1 <br /> Unauthorized Releases Reported [H&SC 252951 <br /> Monitoring Equipment Annual Cert. 23CCR 2630 <br /> over soill container <br /> Cathodic Protection 123CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 26301 <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Meters Calibrated r23CCR 4 i <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-variation Procedure Foliowee) j <br /> _fiTATISTICAL—INVENTORY RECONCILIA ON (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 /> ai y Stick Reacling c <br /> AUTOMATIC TANIL-GAUr,= (ATO) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> nuasummary Report <br /> MANUAL VST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annuai Iankn egri y rest <br /> aanx Uaugingroce ure Followea <br /> Daily Suction Pipincr Monitoring [23CCR Apy. III <br /> Piping Tightness Test r23CCR 2643 b c d <br /> Gravit Pi in Tested Ever 2 Years [23CCR 2643 (e) ] <br /> Monthly Line Test 23CCR 2643 c 2 <br /> Annual <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Remove Closed Or Temporar y Closed23CCR 2670 <br /> REHS p(p�/,��(i 4, Bh,;INSPECTION DATE/TYPE: <br /> RECEIVED BY: y '/ PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br /> PHS 231(9/97( <br />