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PUBLIC HEALTH SERVICES SAN JO UI COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E. Weber Ave. , Third Floor, Stockton, CA 95202 <br /> (209) 468-3420 <br /> UNDERGROUND STORAGE TI (UST) PROGRAM INSPECTION REPORT <br /> 7 <br /> Facility Name S. Program ID# zZ, A 3 <br /> Facility Address �/ 6- 0-� City ZVLA 6 Zip <br /> UST: Dual Wall i1gle Wall_OVERFILL: Audible' UVisual me <br /> Xhanical <br /> PIPING SYSTEM: Dual wallSingle wall Suction Pressure T-l' Gravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (8) requirements? YESNO <br /> 10ATI ONS <br /> TANK # I X5 <br /> UST GENERAL REQUIREMENTS GAI- I <br /> Permit to Operate [H&SC 25284] <br /> Forms A & B--Current H&SC 25 4 C ...... <br /> Monitorinq/Maintenance Records [23CCR 2712 (b) ] <br /> EinanCial ResnonRihility rH&SC 25222 ,2 (a) l <br /> MonitoriM Records Available [23CCR 27121 <br /> Monitorina­Plan [23CCR 2632 (d) (1) ] <br /> Eggponse Plan r22r-CR 2632 (d) (2) l <br /> Unauthorized Releases Reported [H&SC 25295] <br /> Monitoring Equipment Annual Cert. [23CCR 2630 (dTT—' <br /> Over sII ConEaInal Z3CCR <br /> ]2e3=jt--t-j=rj TTRT Penairg r2'ArrR 26611 <br /> Re=jtted IlDurades r,;parri? )rrnl V <br /> Cathodic Protection [23CCR 2635 (a) (2) (A) l <br /> New USTs Monitored Confinuously [23CCR 2630] <br /> MANUAL INVENTORY RECONCILIATION (MIR) - <br /> L23=2 2643 3 <br /> Annual MIR Rep--t- r,-)'z( ( R 2646 (cl) ] <br /> MCLars CalihKgtgd r23CCR 2646 (i) ] <br /> Dai 31z Stick Reading [23CCR 2gAg (el 11 1 1 <br /> aiiai ncr Stick in I/A 113rbgs F23CCR 294r, (r.) (1) (E) <br /> Monthly Variations Calculated [23CCR 2646 (d)] <br /> Ex-Variation Prooedure-Fo=owe d [23CCR 2646 (e) j <br /> 1:11.3; 113" RECX 11101 1 <br /> Inconclusive Procedure Followed [23CCR 2646.1(d) ] <br /> UST Inteqritv Test Every Two Years [23CCR 2646.1E= <br /> Annual SIR Report [23CCR 2646.1 (j) ] <br /> 13aily SEi­c`k-Re`ad—ing- L23CCR 2646--T-cTTITT- <br /> A=0=1 - <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> IMual ATU Summ.ary-Re­po-­rt--F23CCR 27T7 (b) (2) ] <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> =uaI an in egri y est-rZ3UL-R- 2 b 4 b t JD) j <br /> TANK Gauging Proceffu-re`=1owe <br /> d [23CCR-276�) ] <br /> Dgily alIgtign Riping Mgnitgring r23CCR ADr),II1 <br /> Pi in Tightness Test [23CCR- 2643 (b) , (c) , (d) ] <br /> Gravity Piping Tested Every 2 Years [23CCR2643 (e) ] <br /> Monthly Line—Test [23CCR 2643 (c) (2) ] <br /> AnflUaI L��RX Det��CtOr I'esv- LZ-1UUX Zb.3U ka -j <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation 7H&SC-2-5-2-9-81- <br /> Removed--, Close or Tempo-r-a-r-Ly- Closed L2 2670T—' <br /> REHS 6 -INSPECTION DATE/TYPE: P7 DA <br /> RECE4ED BY: PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGEof <br /> PHS 260 (4/98) 4- <br />