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E <br />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 />ERGROUND STORAGE TANK (VST) PROGRAM INSPECTION REPORT <br />Facility Name - - Program ID# <br />Facility Address City I zip <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(g) requirements? YES NO <br />VIOLATIONS <br />aeuvn ri <br />UST GENERAL REQUIREMENTS <br />Permit to Operate [H&SC 25284] <br />Forms A& B Current H&SC 252 4 c <br />Monitoring/Maintenance Records r23CCR 2712(b)] <br />Monitoring Records Available 23CCR 2712 <br />Monitoring Plan 23CCR 2632(d)(1)] <br />Resnonse Plan F23CCR 2632(d)(2)1 <br />Unauthorized Releases Re orted [H&SC 252951 <br />Monitoring Equipment Annua Cert. L23CCR 2630 <br />Over sviii Con.7—ainer <br />Permitted UST Repairq r2.1rrR 26611 <br />Cathodic Protection 23CCR 2635 a 2 A <br />New USTs Monitored Continuously [23CCR 26301 <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />Meters Calibrated F23ccg 2646(i)l <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -variation Procedure Followed L.43CUR ;&b4b(e)j <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 />OMATIC TANK GAUGING (ATr) <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 />nual a'anK integrity lest <br />=R Gauging Procedure koiioweC <br />Daily Suction Piping Monitoring r2 II <br />Piping Tightness Test 23CCR 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 />Annual <br />TANK REMOVAL <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: PHONE: I <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 <br />PHS 260 (4/98) <br />PAGE of <br />