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PUBLIt- HEALTH SERVICES SAN JOAQUIX 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# 3c) t I <br /> Facility Address �j �/ S_ i1i1�-i ��� City LEiIj Zip <br /> UST: Dual Wall. ' Single Wall OVERFILL: Audible Visual_Mechanical <br /> PIPING SYSTEM: Dual wall__r_Single wall Suction Pressure Gravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (g) requirements? YES NO <br /> VIOLATIONS <br /> UST GENERAL REQUIREMENTS TANK # <br /> Permit to Operate [H&SC 252841 <br /> Forms A & B Current H&SC 25284 c <br /> Monitoring/Maintenance Records 23CCR 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 Reported [H&SC 25295] <br /> Monitoring Equipment Annual Cert. 23CCR 2630 .�• <br /> Over spill on ainer <br /> Permit-t-ecj TJqT Repairs r2-;( CR 26611 <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 2630] <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Annual MIR Papnyt f2.-;r( P <br /> Meters Calibrated F23CCR 2646 (i) ] <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-Variation Procecture oiiowect L23CCR 2E)46 (e) j <br /> STATISTICAL INVENTORY RECONCILIATION (SIR) <br /> Inconclusive Procedure Followed [23CCR 2646. 1 (d) ] <br /> UST Integrity Test Every Two Years 23CCR 2646 .1 (q) <br /> Annual SIR Report [23CCR 2646 .1 (j) ] <br /> Daily Stick Reacting c <br /> ANK GAUGING (ATG) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annual Summary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annual Tankn egri y Test <br /> iank Gauging Procecture Poiiowect <br /> PTPTNG MONITORING <br /> Daily Suction Piping Monitoring 23 CR A . II <br /> Piping Tightness Test 23CCR 2643 b c d <br /> Gravity Piping Tested Every 2 Years [23CCR 2643 (e) ] <br /> Monthly Line Test L23CCR 2643 c 2 <br /> Annual eak Detector I'es <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Removed, Closed or Temporar y C ose 23CCR 2670 <br /> REHS ;�, i�tL��- — INSPECTION DATE/TYPE:`//-,7 <br /> RECEIVED BY: i�1G/G:'TZ'� PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE J of_;�_i <br /> PHS 231(9/97) <br />