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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 ?O/,O l.(,/ t-wad�k_ Program ID# JJZg3l z�u <br /> Facility Address u. city zip <br /> UST: Dual Wall Single Wail 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 /> TANK # <br /> QST GENERAL REQUIREMENTS <br /> Permit to Operate [H&SC 252841 <br /> Forms A & B Current LH&SC 25284 (b) (c) j <br /> Monitorin Maintenance Records r23CCR 2712 b <br /> Monitoring Records Available 23CCR 2712 <br /> Monitoring Plan 23CCR 2632 (d) (1) ] <br /> Response Plan 123CCR 26-42 (d) (2) l <br /> Unauthorized Releases Re orted [H&SC 252951 <br /> Monitoring Equipment Annua Cert. L23CCR 2630 <br /> ver spill on ainer <br /> Cathodic Protection 123CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 26301 <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Meters Calibrated F23CCR 2646 (i) l <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-Variation roce ure Followed L23CUR 2646 FeTT <br /> STATISrICAL 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 Reaa—iHg__M!CCRc <br /> AUTOMATIC TANK GAUGING (ATG) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annual Summary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging weekly [23CCR 2645 (b) ] <br /> Annual an n egri y Test <br /> ranX Uaugingroce ure eollowea <br /> PTPTMQ MONITORING <br /> Daily Suction Piping Monitoring 2 R AyD,II1 <br /> Pipincr Tightness Test 123CCR 2643 b c d <br /> Grayit Pi in Tested Ever 2 Years [23CCR 2643 (e) ] <br /> Mont y Line Test 23CCR 2643 c 2 <br /> r <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Removed, riose r Temporar y Closed 23CCR 70 <br /> REHS INSPECTION DATE/TYPE: <br /> RECEIVED BY: PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br /> PHS 260 (4/98) <br />