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0 0 <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 />UNDE GROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility Name '.Jf Program ID# <br />Facility Address_ *a M ��lCe City � Zip�— <br />IIST: Dual Wall Single Wall 0 RFILL: Audible Vis al Mechanical <br />PIPING SYSTEM: Dual wall Single wall_Suction_Pr ssure Gravity <br />DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636(8) requirements? YES NO <br />VIOLATIONS <br />UST GENERAL REQUIREMENTS <br />Permit to Operate [H&SC 252841 <br />Forms A & B Current Ln&SC 25 84 c <br />Monitoring/Maintenance Records r23CCR 2712 b <br />Monitoring Records Available r23CCR 2712 <br />Monitorin Plan 23CCR 2632(d)(1)] <br />Unauthorized Releases Re orted [H&SC 252951 <br />Monitoring Equipment Annua r <br />Cet. L23CCR 2630 <br />ver spill on ainer 23CCR 26i"(JD)i <br />Cathodic Protection 23CCR 2635 a 2 A <br />New USTs Monitored Continuously [23CCR 26301 <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />UST Tnfpa�jt-y Tpst 643_11 <br />Meters Calibrated F23CCg 2646(i)l <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -Variation Procedure Followee)j <br />Inconclusive Procedure Followed [23CCR 2646.1(d)] <br />UST Integrity Test Every Two Years r23CCR 2646.1 <br />Annual SIR Report [23CCR 2646.1(j)] <br />Daily Stick Rea-ffl—ng c <br />AUTOMATIC TANK GAUGING (ATr) <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />Annual ATG Summary Report <br />MANUAL VST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />annual an n egri y es <br />�M7- <br />7anK Gauging roce ure o owe <br />PIPING MONITORING <br />Daily Suction Piping Monitoring r2 R AD II <br />Piping Tightness Test r23CCR 2643 b c d <br />Gravit Pi in Tested Ever 2 Years [23CCR 2643(e)] <br />Mont y Line Test 23CCR 2643 c 2 <br />Annual <br />TANK REMOVAL <br />Permit to Close or Cease Operation LH&SC 25298 <br />Remove ose o Temporar y C ose 23CCR 2670 <br />nrr.o 1N8PECTION DATE/TYPE: <br />RECEI ^D BY: r PHONE: 15— <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br />PHS 260 (4/98) — <br />