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�..p'V A� _ _ .,.. " <br />PUBLIC HEALTH SERVICES SAN JOAQUIN 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 <br />,/ {,Program ID# <br />Facility Address -41) } s� `r�i '� City zip_ <br />UST: Dual Wall Single Wald OVE FILL: 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__I-_' <br />VIOLATIONS <br />UST GENERAL REQUIREMENTS <br />Permit to Operate [H&SC 252843 <br />Forms A & B Current LH&SC 25284(b)(c77 <br />Monitorin Maintenance Records 23CCR 2712 b <br />Financial Responsibility rT-Tr..qC- 29;5).99 2 (a) 1 <br />Monitoring Records Available 23CCR 2712 <br />Monitoring Plan 23CCR 2632(d)(1)] <br />Resnonse Plan r23C!Cg 2632(d)(2)1 <br />Unauthorized Releases Reported [H&SC 25295] <br />Monitoring Equipment Annual Cert. 23CCR 2630 <br />ver spill on ainer L23CCR 2635(b)] <br />Cathodic Protection 23CCR 2635 a 2 A <br />New USTs Monitored Continuously [23CCR 26301 <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />Meters Calibr�ted r23CCR 2646(1)1 <br />Gauging Stick in 1�8 Inches r23CCR 2f;4r,(c)(j)(F)j <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -Variation Procecture o owe e <br />STATISTICAL INVENTORY RECONCILIATION (SIR) <br />Inconclusive Procedure Followed [23CCR 2646.1(d)] <br />UST Integrity Test -Every Two Years 23CCR 2646.1 <br />Annual SIR Report [23CCR 2646.1(j)] <br />Daily Stick Reading c <br />AUTOMATIC TANK GAUGING (ATG) <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />Annual ATU summary Report <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />Annual Tankn egri y Test <br />lanic Uauging Proceaure kolloweu <br />PIPING MO ITORINQw <br />Daily Suc ion <br />Pi -ping Monitorinct2 R App.III <br />Piping Tightness Test` 23CCR 2643 b c d <br />Gravity Piping Tested Every 2 Years [23CCR 2643(e)] v <br />Monthly Line Test L23CCR 2643 c 2 <br />Mnuai Eeax Detector <br />TANK REMOVAL 1 <br />Permit to Close or Cease Operation H&SC 25298 <br />Removed, Closed or Temporar y Closed 23CCR 2670 <br />REHS INSPECTION DATE/TYPE: <br />RECEIVED BY: +�LtL� PHONE: IZS - S+fZ' (np2 <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE ,of <br />PHS 260 (4/98) <br />