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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 ���`-J 6"-/' I/" ' Prnnram TT14+ <br />M- l.T}1 U <br />UST GENERAL REQUIREMENTS <br />Permit to Operate [H&SC 252841 <br />Forms A & B Current H&SC 25284 c <br />Monitoring/maintenance Records 23CCR 2712(b)] <br />Financial Responsibility FH&SC 21-,292 2(a)l <br />Monitoring Records Available 23CCR 2712 <br />Monitoring Plan [23CCR 2632 (d) (1) ] <br />Res-ponse Plan [23CCR 2632(d)(2)1 <br />Unauthorized Releases Reported [H&SC 25295] <br />Monitoring Equipment Annual Cert. 23CCR 2630 <br />Over slDili Container L23CCR 2635(b)] <br />Permitted UST Renairs [2-=R 26Cjj <br />Cathodic Protection 23CCR 2635 a 2 A <br />New USTs Monitored Continuously [23CCR 2630] <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />UST Tntearitv T( -.qt 123CCR 2e4311 <br />Meters r 2 R 2 4 i <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -Variation ProceUure Foiiowecl [23CCR-77479(e)] <br />STA'ISTICAL 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 />Annuai A7G Summary-7-e—port <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />Annuai Tankn egri y es <br />Tank auging Proceciure Foiiowed <br />PIPING, MONITORING <br />Daily Suction Piping monitoring r2 CR Avy.III <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 />Annuai Leak oetector s <br />TANK REMOVAL <br />Permit to Close or Cease Operation H&SC 25298 <br />Removed, 77 --se or Temporar y Closed 23CCR 2670 <br />REHS <br />RECEIVED BY: <br />INSPECTION DATE/TYPE: <br />PHONE: <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br />PHS 260 (4/96) <br />Facility Address <br />-/I <br />' <br />City <br />zip <br />UST: Dual Wall Single <br />Wall OVERFILL: <br />Audible <br />Visual_ Mechanical <br />PIPING SYSTEM: Dual wall <br />=Single wall <br />Suction <br />Pressure Gravity <br />DOES THE LEAK DETECTION <br />SYSTEM meet 23CCR <br />2636(8) <br />requirements? YES NO <br />VIOLATIONS <br />M- l.T}1 U <br />UST GENERAL REQUIREMENTS <br />Permit to Operate [H&SC 252841 <br />Forms A & B Current H&SC 25284 c <br />Monitoring/maintenance Records 23CCR 2712(b)] <br />Financial Responsibility FH&SC 21-,292 2(a)l <br />Monitoring Records Available 23CCR 2712 <br />Monitoring Plan [23CCR 2632 (d) (1) ] <br />Res-ponse Plan [23CCR 2632(d)(2)1 <br />Unauthorized Releases Reported [H&SC 25295] <br />Monitoring Equipment Annual Cert. 23CCR 2630 <br />Over slDili Container L23CCR 2635(b)] <br />Permitted UST Renairs [2-=R 26Cjj <br />Cathodic Protection 23CCR 2635 a 2 A <br />New USTs Monitored Continuously [23CCR 2630] <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />UST Tntearitv T( -.qt 123CCR 2e4311 <br />Meters r 2 R 2 4 i <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -Variation ProceUure Foiiowecl [23CCR-77479(e)] <br />STA'ISTICAL 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 />Annuai A7G Summary-7-e—port <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />Annuai Tankn egri y es <br />Tank auging Proceciure Foiiowed <br />PIPING, MONITORING <br />Daily Suction Piping monitoring r2 CR Avy.III <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 />Annuai Leak oetector s <br />TANK REMOVAL <br />Permit to Close or Cease Operation H&SC 25298 <br />Removed, 77 --se or Temporar y Closed 23CCR 2670 <br />REHS <br />RECEIVED BY: <br />INSPECTION DATE/TYPE: <br />PHONE: <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br />PHS 260 (4/96) <br />