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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 Name1�6-f6P�'4e) j'7 Program ID# �� j �- <br />Facility Address �'� ( City "p [; hi�zip �? rte <br />UST: Dual Wall_Single Wall OVERFIL • Audible VisualMechanical <br />PIPING SYSTEM: Dual wall Sing a wall_�a/�....Suction Pressure Gravity <br />DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636(g) �irements? YES NO� <br />VIOLATIONS <br />VST GENERAL R8 UIREMENTS~,� w <br />Permit to Operate [H&SC 252841 <br />Forms A & B Current LH&SC 252r47c <br />Monitorin Maintenance Records 23CCR 2712 b <br />Monitorin Records Available 23CCR 2712 <br />Monitorin Plan 23CCR 2632(d)(1 <br />Unauthorized Releases Re orted [H&SC 252951 <br />Monitoring Equipment Annua Cert. L23CCR 2630 <br />ver s i on alner L23CCR 2635(b)] <br />Permitted UAT Rppir-q [21= 2f;611 <br />Cathodic Protection 23CCR 2635(a) 2 A <br />New USTs Monitored Continuously [23CCR 26301 <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -Variation Proceaure Followed L;13CCR 26467e= <br />STATISTICAL INVENTORY RECONCILIATION (SIR) <br />Inconclusive Procedure Followed [23CCR 2646.1(d)] <br />UST Integrity Test Ever Two Years 23CCR 2646.1 <br />Annual SIR Report [23CCR 2646.1(j)] <br />Daily is ea ing c <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />Annual ummary Report <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />Annual anx integrity rest <br />iank Uauging Proceaurekollowect <br />PIPINQ MONITORING <br />Daily Suction Piping Monitorino <br />Piping Tightness Test f23CCR 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 />TANK REMOVAL <br />Permit to Close or Cease Operation H&SC 25298 <br />Removed, Closed or Temporar y Clos ed 23CCR 70 <br />RENS INSPECTION DATE/TYPE: <br />RECEIVED BY: PHONE: <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE L of ,Z <br />PHS 260 (4/98) <br />6j, <br />