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PUBLIREALTH SERVICES SAN JOAQUI19COUNTY <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 644@!!� Program ID# <br /> Facility Address City 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-5- YES—NO <br /> VIOLATIONS <br /> UST GENERAL REQUIREMENTTANK # <br /> S <br /> Permit to Operate [H&SC 25284] <br /> Forms A & B Curren�tH�&SC25284cjl <br /> MonitoringZmaintenance Records [23CCR 2712 (b) ] <br /> Financial Resnonsibility rH&SC 2S292.2 (a) ] <br /> Monitoring Records Available [23CCR 2712] <br /> MonitorinS Plan [23CCR 2632 (4) (1) ] <br /> Rpnnnnse Plan f23CCR 2fi:12 (d) (2) 1 <br /> Unauthorized Releases Reported [H&SC 25295] <br /> --Monitoring Equipment Annual Cert. [23CCR 2630 <br /> ver sII confalner [21CCR 2635 -YF <br /> PerMitted JIST RpnairR r9ircp gggii <br /> ]2e3-Mjtt,-r1 TTner'r=A=a r�).,;rrp ->rrnl <br /> Cathodic Protection [23CCR 2635 (a) (2) IA) l <br /> New USTs Monitored Continuously [23CCR 2630] <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> 11ST Int - - L-La3r.CB—Z <br /> A=Ual MTP Por)riyj- <br /> Meters Cglibrgtgd r23ggg <br /> Qa])Uina StiCk in JZ8 Tnehes r23CCR 2kAfi_Laj.LjJ_CELL_ <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-Vafflation -Pr—oceaure Followea [23CCR 2646 (e3j <br /> REr.QKQ1L1AT1Qx (Big) <br /> Inconclusive Procedure Followed [23CCR 2646.1 (d) ] <br /> UST Integrity Test Every Two Years [23CCR 2646.1Lq)j__ <br /> Annual SIR Report [23CCR 2646.1 (j) ] <br /> Daiiy S is Reading-123-CCR--2646 (c) (1) ] <br /> GAUGING (ATra) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> AnnuaI ATG Summary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> A,nnual an Integrity Test [23CCR 2645 (r53 ] <br /> -'ra-n-7"'Gauging Proce?1ure-F537owe <br /> U <br /> 2IRING XONITORIMG <br /> Daily Suction Pining Mg r2 App.III <br /> Piping Tightness Test [23CCR 2643 (bc) , (d) j <br /> Gravity Pi in Tested Every 2 Years [23CCR 2643 (e) ] <br /> Monthly Line Test L23CCR 2643 (c) (2) ] <br /> Annuai LE&7"Die-fector Tesr---L-Z3L-CK-25-3U (a) <br /> TANK REMOVAL <br /> Permit to Cloq6 or Cvase Operation H&SC 252981 <br /> Removed, C os or Te porar v Closed23CCR 2670 <br /> REHS -71 INSPECTION DATE/TYPE: <br /> RECEIVED- PHONE: <br /> 4v <br /> f - - <br /> 4y <br /> Revised Date 7/15/97 231iRUST Regs May 5, 1994 PAGE f of <br /> PHS 231(9/97) <br />