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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 A)V AI $ / Program ID# <br /> Facility Address 33EG1. -0 57- City A21AA Zip <br /> UST- Dual Wall Single Wall OVERFILL: Audible Visual Mechanical <br /> PIPING SYSTEM: Dual wall Single wall Suction_Pressure Gravity <br /> DOSS THE LEAK DETECTION SYSTEM meet 23CCR 2636 (8) requirements? YES NO <br /> VIOLATIONS <br /> TANK # <br /> UST GffiIIBRAL REQUIREMENTS <br /> Permit to erste [H&SC 252841 <br /> orms & B urrent iH&SC 25284 c <br /> Monitoring/Maintenance Records 23CCR 2712 b <br /> Financial Responsibility FHrSC 252929 (a) l <br /> Monitoring Records Available 23CCR 2712 <br /> Monitoring Plan 23CCR 2632 d 1 <br /> Unauthorized Releaaes Re orted [H&SC 25295] <br /> Monitoring Equipment Annus Cert. L23CCR 2630 <br /> Over spill on ainer <br /> Cathodic Protection 123CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 26301 <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Meters Calibrated r23CCR 2646 (i) l <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-variation Proceaure Followect L;&3CCX 2646te) j <br /> TIChL INVENTORY RECONCILIATION (SIR) <br /> Inconclusive Procedure Followed 23CCR 2646.1(d) <br /> UST Integrity Teat Every Two Years 123CCR 2646.1 <br /> Annual SIR Report [23CCR 2646.1(j) ] <br /> Daily Stick Reading L23CCR 26TU78) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annual summary Report <br /> MANUAL UST TANK GAUGING (NTG) <br /> Tank Gauging Weekly [23CCR 2645(b) ] <br /> Annual n egri y 'rest L2-'CCK 264b (D) j <br /> TanK Uaugingroce ure -011-we <br /> M <br /> Piping Tightness Test 123CCR 2643 b c d <br /> Gravit Pi in Tested Eve 2 Years 123CCR 2643 (e) ] <br /> Mont y Line Test 23CCR 2643 c 2 <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25296 <br /> emove Closedor Temporar y ose 70 <br /> RENS J4 INSPECTION DATE/TYPE: <br /> RECEIVED BY: PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br /> PHS 260 (4M) <br />