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10 4 <br />PUBLI HEALTH SERVICES SAN JOAQUIPCOUNTY <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-fo-�P%NA LNd&JZ Program ID# <br />Facility Address ItSb +, �CgWba;+e 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(8) requirements. YES NO <br />VIOLATIONS <br />UST GENERAL REQUIREMENTS <br />Permit to 22erate [H&SC 25284] <br />Forms A & B Current LH&SC 25284c)j <br />MonitoringZMaintenance Records r23CCR 2712(b)] <br />FinanCjal RpRnnnsibilitv rH&SC 2c;29U_2(d)] <br />Monitoring Records Available [23CCR 2712] <br />Monitorinq Plan [23CCR 2632(d)(1)] <br />Eggponsp Plaj�,_ " la,"R 2632 <br />Unauthorized Releases Reported [H&SC 25295] <br />Monitoring I'Equipment Annual Cert. [23CCR 2630TETT-' <br />-ver sill Container [23CCIZ 2Z;35(TD)1 <br />Pprmittpd TTST RpnairA MrCR 26611 <br />ParMitt,mej Uncrr;;rip-a r,),zrrp 26601 <br />Cathodic Protection [23CCR 2635(a)(2)(A)] <br />New USTs Monitored Continuously [23CCR 2630] <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />.-P-crrit7v Tp- 41-11 <br />vinii=1 MTP <br />-U11L-RePart [23CCR 29441-11 <br />Meters---Q�Fij:Ar.Qgj <br />r,aimy'na Stink j <br />W3 W <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -Variation Prode d'urs —F-o=owe d [23CCR ;9b4bte)j <br />_aTAjjfiTjg&L ON (STR) <br />Inconclusive Procedure Followed [23CCR 2646.1(d)] <br />UST Integrity Test Every Two Years [23CCR 2646.1(q)l 1 <br />Annual SIR Report [23CCR 2646.1(j)] <br />Daily is Reading-1-23CCR 2646 T-cTTI)j <br />Monthly ATG Results [23C -CR 2643(b)(1)] <br />Annual ATG summary-Repor-t--123CCR 2712(b)(2)j <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging weekly [23CCR 2645(b)] <br />Am= an InEegflty Test [23CCR 2645(5)] <br />aTIR GauqlTig rocs urs Foi-Iowed (23CCR 264bta)j <br />Dgily allgLign Riping Mgnitoring r23QCR Anp.II] <br />Piping Tightness Test [23CCR 2643(b),(c),(d)] <br />Gravity Piping Tested Every 2 Years [23CCR 2643(e)] <br />Monthly Line Test L23CCR 2643(c)(2)T— <br />=UaI Leak DeE��cUor 'resr- [23CCR 263uku)j <br />TANK REMOVAL <br />Permit to Close or cease operation [H&SC 252981 <br />Remove C os or-Temporarly Closed [23CCR 267-0-F— <br />RECEIVED BY: <br />INSPECTION DATE /TYPE: _C;7fM <br />PHONE: <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE__I_off2 <br />PHS 231 (9/97) <br />