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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 i <br /> Facility"`NameProgram ID# <br /> Facility Address > City �>� Zip 05 <br /> UST: : Dual Wall Szrigle Wall y OVERFILL: Audible Visual� _Mechan cal <br /> PIPING SYSTEM: Dual wall Single wall Pressure Gravity <br /> DOES THE 'LEADETECTION SYSTEM meet 23CC ,SuctionR 2636 (g) requirements? YES NO �( <br /> It <br /> VIOLATIONS <br /> UST GENERAL RE DIREMENTS TANK # <br /> Permit to Operate [H&SC 25284] <br /> Forms A & B Current H&SC 25284 c <br /> MonitorinMaintenance Records r23CCR 2712 b <br /> Monitorin1 Records Available 23CCR 2712 <br /> Monitorin Plan 23CCR 2632 (d) (1) ] <br /> Unauthorized Releases Re orted [H&SC 252951 <br /> Monitoring Equipment Annua Cert. 2 3-CCR 2630 <br /> vers z on a>ner <br /> I <br /> Cathodic Protection f23CCR 2635 a 2 A <br /> New USTs Monitored Continuously23 <br /> [23CCR 26301 <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Mete 11 23CCg 2646 (1) 1 <br /> i <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> t <br /> x- aria zon Procedure Followed L23=x 2646 (e) <br /> Inconclusive Procedure Followed [23CCR 2646.1 (d) ] <br /> UST Integrity—Test Every Two Years f23CCR 2646.1 <br /> Annual SIR Report [23CCR 2646.1 (j) ) i <br /> Daily. zc ea ing c <br /> n <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annuaummary epor <br /> MANUAL USTITANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> ua an n egri y es <br /> an aug>ng roce ure FolloweQ <br /> r— <br /> Daily 7SUCtign ipina Monitoring 2 R A .Il <br /> Pip ncr Tightness Test. 23CCR 2643 b c d <br /> Gravitv Pipincr Tested Every 2 Years [23CCR- 2643 (e) ] <br /> Mont i <br /> y Line Test 23CCR 2643 C 2 <br /> u <br /> TANK REMOVAL <br /> Permit to C ose or Cease Operation H&SC 25-2-98-7-- <br /> Removed, <br /> 5298 Remove C o5ea or Temporar y Closed 23CCR 2670 f <br /> REHS <br /> INSPECTION DATE/TYPE: <br /> RECEIVED BY: PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE �• <br /> PHS 260 (4/98) <br />