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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/lj1.t ar"l 'jlrh(L( Program ID# <br /> Facility Addresst; Cc" K ilh"�' �1 `1 City'�I�1(.� i �7(�t Zip <br /> UST: Dual Wall 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 (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 /> Monitorin Plan 23CCR 2632 (d) (1) ]�-�sp�onse Plan r23CCR 2632 (d) (2) 1 , <br /> Unauthorized Releases Reported [H&SC 25295] <br /> onitoring Equipment Annual Cert. 23CCR 2630 <br /> ver spili Container <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 2630] <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Meters Calibrated [23CCR 2646 (1) 1 <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-Variation Procecture Foiiowect L23CCR 2646 (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 <br /> Annual SIR Report [23CCR 2646 .1 (j) ] <br /> Daily Stick Reading c <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 /> Annuai Tankn egri y es <br /> anGauging Proceclure Foiiowecl <br /> PIPING MONTTORTNa <br /> Daily Suction Piping Monitorincr r23CCR Avy.III <br /> \"Pipinq 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 /> A Annuai Leax Detector lest L23UCR 263Uka) j + <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Removed, Closed or Temporar y Closed 23CCR 2670 <br /> REH INSPECTION DATE/TYPE: <br /> RECEIVED BY:�Sc� 1 PHONE <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br /> PHS 260 (4/98) <br />