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b <br /> PUBLIC HEALTH SERVICES SAN JON 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#-?Z / 77 <br /> Facility Address / a City 0— zip <br /> UST: Dual Wall v' Single W- 1 - OVERFILL: Audibl Visual Me ani�a <br /> PIPING SYSTEM: Dual wall -- Single wall Suction Pressure V rav>ty_ <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (g) requirements? YES NO <br /> VIOLATIONS <br /> TANK # <br /> UST GENERAL REQ11REMENTS <br /> Permit to Operate [H&SC 25284] <br /> Forms A -C—B Current H&SC 25 84 ��;1�' <br /> monitoriMZMaintenance Records r23CCR 2712 (b) ] <br /> Financial Resnanp-i-bility rR&SC 2S292 ja) ] <br /> Monitoring Records Available [23CCR 27121 <br /> Monitoring Plan [23CCR 2632 (d) (1) ] <br /> ap..932glIgge Elan r23(!(!R 2632 (d) (2) 1 <br /> Unauthorized Releases Reported [H&SC 25295] <br /> Monitoring Equipment Annual Cert. [23CCR 2630 (d)7- <br /> 11 Con ainer <br /> ReXMitted UAT RpnAirR r2lrrP 26611 <br /> PP-Tr-Tmnitt--t-- d i1pgrades r2lrrP 999nl <br /> Cathodic Protection [23CCR 2635 (a) (2) JA <br /> New USTs Monitored Continuously [23CCR 2630] <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Tntagrity T 4- -1 <br /> Meters Cal ibr&t-gegdL_LrZ23_QgR 2646 M 1 <br /> Dail- -qt-ick gaadi]3a r,;-Arri? >646 (c) (3 ) 1 <br /> Gauall-na Stick in 1�R Tnr-,hpq (23=R 2f;4r, (n1 (1) (Ell <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-V-aria Eion Procedure Fo1l-ow­ed--L2-3= 2646 (e3j <br /> SIR)1� Q ii Z <br /> Inconclusive Procedure Followed [23CCR 2646.1 (4) ] <br /> UST Integrity Test Every Two Years [23CCR 2646.1 (gl] <br /> Annual SIR Report [23CCR 2646.1(j) ] <br /> DaiIy is Reading L23CCIZ" 2-6-46 (c) (1) 1 <br /> &=9=1C T GAUG a (ATO) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> =Mual ATG Summary Report L23CCR--271ZTbT-C2T-J- <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> 7=uai Tanx Integrify Test [23CCR 2645 UD) <br /> an au Gau-Ing­-P-rocs-Curs o-lT-0WeU '2645 (ZI) <br /> TORTM." <br /> Daily alagtiga Ril2incr Monitoring (23 Ca ARp,11] <br /> Piping TiShtness Test [23CCR. 2643 (bl , (cd) ] <br /> Gravity Pi in Tested Every 2 Years [23CCR2643 (e) ] <br /> Monthly Line Test [23CCR 2643 (c) (2) ] <br /> 7=uaI LeaX DEteCr5f TeNE [23CCR 2630 (a-) -j <br /> TANK REMOVAL <br /> Permit to Close or cease Operation [H&SC 252981 <br /> Remove Closed or TepV <br /> A /7 9r�arly Z!Iosed [23CZ!rZ 2670T <br /> REHS jINSPECTION DATE/TYPE '' 7- 4 <br /> RECEIVED PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGEof <br /> PHS 260 (4/98) <br />