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PUBLIIHEALTH SERVICES SAN <br />ENVIRONMENTAL HEALTH <br />304 E. Weber Ave., Third Floor, <br />(209) 468-3420 <br />JOAQU9 <br />DIVISION <br />Stockton, <br />COUNTY <br />CA 95202 <br />UNDERGROUND TORA/IGH TANK (UST) PROGRAM INSPECTION REPORT <br />Facility NameSr'A C,,,�,y(' (/I Program ID# `Zig A)7 3 <br />Facility Address? -7 I -T cmc," City S zip 55? -Z7 <br />UST: Dual Wall Single Wall OFERFILL: 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 />VIOLATION3 <br />a.u.w x <br />UST GENERAL R8 UIREMENTS <br />Permit to O erste [H&SC 252841 <br />orms A& B urrent H&S 2 4 c <br />Monitorin Maintenance Records 23CCR 2712 b <br />Financial Rennonsihility rT4FSC 2q292 -2(A)1 <br />Monitoring Records Available 23CCR 2712 <br />Monitoring Plan 23CCR 2632 d 1 <br />Response Plan F23CCR 2632(d)(2)1 <br />Unauthorized Releasee Re orted [H&SC 252951 <br />Monitoring Equipment Annus Cert. L23CCR 2630 <br />ver spill on ainer L23CCR 2635(b)] <br />Cathodic Protection r23CCR 2635 a 2 A <br />New USTs Monitored Continuously [23CCR 2630] <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />meters ibr 4 <br />aauaina stink in I/R Inches [23CCR 2646(c)(1)(E)l <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -Variation Procedure Followee)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 />ai y stick Reading c <br />AUT TIC TANK r.AUGTWQ IhMrl <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 an n egri y lest <br />lank Gauging Procedure kolloweU <br />Daily Suction Pipincr monitoring r23CCR Ap I <br />Pivincr 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 />Annual e <br />TANK REMOVAL <br />Permit to Close or Cease Operation H&SC 25298 <br />RemoveT,- Mosed or Temporar y Closed L23CCR 2670 <br />REHS INSPECTION <br />RECEIVED BY: <br />Revised Date 7/15/97 <br />PHS 231 (9107) <br />DATE/TYPE: q 7 <br />PHONE: / <br />23 CCR UST Regs May 5, 1994 PAGE 1 of_� <br />