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PUBLI"HEALTH SERVICES SAN JOAQUII,�COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E. Weber Ave. , Third Floor, Stockton, CA 95202 <br /> (209) 468-3420 <br /> UNDERGROUND STORAGE TANK (VST) PROGRAM INSPECTION REPORT <br /> Facility Name /�-AViL3 p,Fp=1-1�— <br /> Program ID# <br /> Facility Address / /VZs4yrAf_o <br /> Zi <br /> UST: Dual Wall Single Wall OV FILL: Audible /Visual chanical <br /> PIPING SYSTEM: Dual wall Single wall SuctionPressure MeGravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (8) requirements? YES NO <br /> VIOLATIONS <br /> UST GENERAL REQUIREMENTS TANK # <br /> Permit to 0 erate [H&SC 25284] <br /> Forms A & B Current H& 25 4 c <br /> Monitorin Maintenance Records 23CCR 2732 (b) <br /> Monitorin Records Available 232CR 2712 <br /> Monitor in Plan [23CCR 2632 d) (1 <br /> Unauthorized Releases Re orted [H&SC 25295] <br /> Monitoring Equipment Annua Cert. L2JCUR 2630 <br /> ver s i on ainer <br /> tp,q <br /> TTqT <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� j <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> EX-Variation—Procedure Followee) j <br /> STA ISTICAL_INVENTORY RECONCILIATION (Sig) <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 /> Annual Summary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annual an n egrl y lest <br /> -755-nR Gauging Procedure oiiowea <br /> PIPING MONITORING <br /> Daily Suction Piping Monitoring f2 R App. Ill <br /> Piping Tightness Test 23CCR 2643 b c d <br /> Grayit Pi in Tested Ever 2 Years [23CCR 2643 (e) ] <br /> Mont y Lixae Test 23CCR 2643 c 2 <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Removed, Closedor Temporar y Closed 23CCR 2670 <br /> REHS INSPECTION DATE/TYPE: �'-�`�✓AL $= �i <br /> RECEIVED BY: PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br /> PHS 231(919'1) <br />