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PUBLI�HEALTH SERVICES SAN TOAQUIICOUNTY <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_ �•�, <br />Program ID# <br />Facility Address 3Q(ow L'e�n..� '+ <br />UST: Dual Wall Single Wall W°L" CityZip <br />PIPING SYSTEM:—5-- _OVERFILL: Audible Vi ual Mechanical <br />ual wall Single wall Suction Pressure Gravity <br />DOES THE LEAK DETECTION SYSTEM meet 23CCR 22636(g) requirements? YES NO <br />VIOLATIONS <br />maam u <br />Vol 1 MUSRAL R!22IREMENTS <br />Permit to O eate [H&SC 252841 <br />Forms A & B Uurrent lki&SU 25284 c <br />Monitoring/Maintenance Records 23CCR 2712 b <br />Monitoring Records Available 23CCR 2712 <br />Monitoring Plan 23CCR 2632(d)(1) <br />Response Plan F23CCR 2632(ri)(2)1 <br />Unauthorized Releases Reported [H&SC 252951 <br />Monitoring Equipment Annua Cert. 23CCR 2630 <br />Over spiii Container 1;13CCR 2635(b)] <br />Cathodic Protection 23CCR 2635 a 2 A <br />New USTS Monitored Continuously [23CCR 26301 <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />meters Calibrated 123CCR 2646(i)l <br />Monthly Variations Calculated [23CCR 2646(d)] <br />x- aria ion Procedure Foiiowee)J <br />_MTISTICAL 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 Reacting c <br />AUTOMATIC TANK raTTGTNG (ATC) <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />Annuai ATG Summary Report <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />nual 1'anK integrity lest <br />lank Uauging Vroceclure o owe <br />PTPTNa MONITORING <br />Daily ion Pilpina Monitoring r23CCR Apy.II1 <br />Piping Tightness Test 23CCR 2643 b c d <br />Gravit Pi in Tested Ever 2 Years [23CCR 2643(e)] <br />Month y Line Test 23CCR 2643 c 2 <br />Annuai <br />TANK REMOVAL <br />Permit to Close or Cease Operation H&SC 25298 <br />Remove C ose or Temporar y Closed 23CCR 2670 <br />P PP <br />REH INSPECTION DATE/TYPE: T- <br />RECEIVED BY: <br />PHONE: <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br />PHS 231 (8/87) <br />