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+r <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 />Facility NameL 6ZY y�/;j( llf Program ID# �. <br />Facility Address_�J :��f'�� �'`� i�ir,ft City Zip <br />UST: Dual Wall ,,;,Single WaIr OVERFILL: Audible Visual_Mechanical <br />PIPING SYSTEM: Dual wall t� Single wall Suction PressureGravi,ty <br />DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636(8) requirements. YES.`YNO <br />VIOLATIONS <br />UST GENERAL REQUIREMENTS <br />Permit to Operate [H&SC 252841 <br />Forms A & B Current LH&SC 25284 c <br />Monitoring/Maintenance Records 23CCR 2712 b <br />Financial Responsibility rRkSC 299,99-9.(a)l <br />Monitoring Records Available 23CCR 2712 <br />Monitoring Plan 23CCR 2632(d)(1)] <br />Response Plan r2lrCR 2632(d)(2)1 <br />Unauthorized Releases Reported [H&SC 252951 <br />Monitoring Equipment Annual Cert. 23CCR 2630 <br />ver spill on ainer <br />Cathodic Protection 23CCR 2635 a 2 A <br />New USTs Monitored Continuously [23CCR 2630] <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />Meters Calibrated [23CCR 264�(I)j <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -variation Procedure Foilowea L23CCR=b(e)j <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 />AUTOMATIC TANK GAUGING (ATO) <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />Annual ATU Summary Report <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />Annual Tanxn egri y 7est <br />iank Uauging Proceaure kollowed <br />RING <br />Daily Suction Piping Monitoring r2 R Apy.II1 <br />Piping Tightness Test 23CCR 2643 b c d <br />Gravity Piping Tested Every 2 Years [23CCR 2643(e)] <br />Monthly Line Test 23CCR 2643T3T7-27T-- <br />Annual LeaX Detector <br />TANK REMOVAL <br />Permit to Clse or Cease Operation H&SC 25298 <br />Remove se or porar y Closed 23CCR 2670 <br />.,I <br />REHS ,��1) ,--`'�y? INSPECTION DATE/TYPE : �% few.. <br />RECEIVEDPHONE BY: )` <br />;'L..W ' -� w s=�� <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br />PHS 260 (4/98) <br />