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Ed <br />LN <br />00 <br />;. a , ..r � r' an v r . _. _..� , .►.�—^w. �irtvww.. ^r"'*�F 8��': Z _ <br />11 <br />PUBLIC HEALTH SERVICES SAN <br />ENVIRONMENTAL HEALTH <br />304 E. Weber Ave., Third Floor, <br />(209) 468-3420 <br />JOAQUIN COUNTY <br />DIVISION <br />Stockton, CA 95202 <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility Name �' r ProgrV. <br />am ID# .D 5 �A <br />Facility Address � � �+- Cit Y. Zi ;i tfi <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 -5 -YES -NO <br />VIOLATIONS <br />isaa\r tt <br />UST GENERAL REQUIREMENTS <br />Permit to Operate [H&SC 252841 <br />Forms A & B Current LH&SC 25284 c <br />Monitorin Maintenance Records 23CCR 2712(b)] <br />Monitoring Records Available 23CCR 2712 <br />Monitoring Plan 23CCR 2632(d)(1)] <br />Resi)onse Plan r23rCR 2632(d)(2)1 <br />Unauthorized Releases Reported [H&SC 252951 <br />Monitoring Equipment Annual Cert. L23CCR 2630 <br />Over spill on ainer <br />Cathodic Protection 23CCR 2635 a 2 A <br />New USTs Monitored Continuously [23CCR 2630] <br />+r i <br />I MANUAL INVENTORY RECONCILIATION (MIR) <br />Meters Calibr�ted R 2646(1)1 <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -Variation Procecture FoliowecL L23CCH ;eb4b (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 (ATO) <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />nua ummary Report <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />nua-L Tanx integrity Iest <br />lank Uauging Proceaure kollowea <br />TORTNG <br />Suction Piping Monitoring r2 R A .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 <br />Annual e r lest <br />TANK REMOVAL <br />Permit to Close or Cease Operation H&SC 25298 <br />Removed, Closed or Temporar y Closed 23CCR 2670 <br />AEHS j . 'L 4k9PECTION DATE/TYPE: <br />RECEIVED BY: PHONE: A!�'� <br />Revised Date 7/15%97 23 CCR UST Regs May 5, 1994 PAGEof <br />PHS 260 (4/98) <br />