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PUBLIPHEALTH SERVICES SAN JOAQU91COUNTY <br />ENVIRONMENTAL HEALTH DIVISION <br />304 E. Weber Ave., Third Floor, Stockton, CA 95202 <br />(209) 468-3420 <br />UNDERQROUND STORAGE TANK (US ) PROGRAM INSPECTION REPORT <br />7W <br />Facility Name / f I [/ off , I -r/ I JJA rogram ID# <br />Facility Address. city --- zip <br />UST: Dual Wall Single Wall 'OVERFILL: Audible ' Vis *al mechanical <br />PIPING SYSTEM: Dual wall Single wall Suction Pressure -Gravity <br />- <br />DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636(g) requirements? YES NO <br />VIOLATIONS <br />UST GENERAL REQUIREMENTS <br />Permit to 02erate [H&SC 25284] <br />Forms A & B current LH&SC 25284(5)(c3l <br />monitoringZMaintenance Records [23CCR 2712(b)] <br />Financial RasnnnRihilitv rH&RC 2S292-2(a)l <br />Monitoring Records Available [23CCR 2712] <br />Monitoring Plan [23CCR 2632(d)(1)] <br />-Rasnonse Plan r2lCrR 2632(d)(2)] <br />Unauthorized Releases Reported [H&SC 25295] <br />MonitoringEquipmentAnnual-Cert. -T-23CCR 2630(d)j <br />Over sp= <br />.L_I- C!Sntainer L23CCR 2635 jb2 1- <br />Pprmit--t,tmd T7.qT Ptmnairiq r2'ArrR 26611 <br />Rermit' ' ---- . es [23CCR '7rrnl <br />Cathodic Protection [23CCR '2635(a)(21(A)] <br />New USTs Monitored Continuously [23CCR 2630] <br />MANUAL INVENTORY RECONCILIATION(MIR) <br />--losm:110 � S '1643. 11 <br />Annual MIR Repprt r,>,arrp iGAE (g) 3 <br />Meters libratc cc till <br />pailg Stick Re -2AAA-tnAJ 1 ) I <br />-GaiigIng Stick in I/A -Tnt-hf--q r2,;rrp <br />Monthly VariationsCalculated[23CCR 2646(d)] <br />Ex-Varlation Procedure Fo lowed L23CCR 2649(e)l <br />8Z=j8TICAL_jM=== gZC ILIATION (SIR) <br />Inconclusive Procedure Followed [23CCR 2646.1(d)] <br />UST Intecrritv Test Every Two Years [23CCR 2646.1(q)l 1 <br />Annual SIR Report [23CCR 2646.1(j)] <br />Daily is Reading [23CCR 2646 (c)(1)j <br />a OLTa I <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />==ua AxU 5ummary Report [23CCR 2712(b) (2)] <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />Annual 7afIR IFIf9grity TEst (23CCR 26215 (B) I <br />T'NftTc au an Procedure Followed L:&JCCR 2645(ff)] <br />21 G <br />LDA"ly S119tign Pi2ing Mgaitorina r23QQR App.JIL <br />Pi in Tightness Test [23CCR 2643(b),(c),(d)] <br />Gravity Piping Tested Every 2 Years [23CCR2643(e)] <br />Monthly Line Test L23CCR 2643(c)(2)) <br />Annual LeaK DetaCE5r TeSU"[23CCR 2630ka)i <br />TANK REMOVAL <br />r <br />---V$JGJ.QI..1V til W Z74 -, 0 j <br />Remove os or T=emporarly Closea [23CCR 2970) <br />REHS —INSPECTION DATE/TYPE: <br />RECEIVED BY: <br />Revised Date 7/15/97 <br />PHS 239 (07) <br />-t4 <br />23 CCR UST Regs May 5, 1994 PAGE of® Z� <br />