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0 <br /> PUBLI 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 /> _ <br /> Facility Name r-�rogram ID# <br /> Facility Address1 ; ACitytC Zip [ �7 <br /> UST: Dual Wall Single Wall OVERFIL Audible Visual Mechanical <br /> PIPING SYSTEM: Dual wall Single wall Suction Pressure Gravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23C�636 (g) requirements? YES N0:>�:: <br /> VIOLATIONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&SC 252841 <br /> Forms A & B Current H&SC 25284 c <br /> Monitoring/Maintenance Records r23CCR 2712 (b) ] <br /> Monitoring Records Available 23CCR 2712 <br /> Monitoring Plan [23CCR 2632 (d) (1) ] <br /> Regnonse Plan r23ccg 2632 (d) (2) 1 <br /> Unauthorized Releases Reported [H&SC 25295] <br /> Monitoring Equipment Annual Cert. 23CCR 2630 <br /> Over spill Container L23CCR 2615 (15) ] <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 26301 <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> UST Tntea- ity Test [230 <br /> meters i ra [23CCR 2 4 i <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-Variation Procedure Foliowee) <br /> STATISJICAL INVENTORY RECONCILIATIOkl (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 Reading c <br /> AUTQMAT3:C 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 /> nual 'fank Integrity es <br /> lank uauging Procedure olicwecl <br /> PTPTNr. MONITORING <br /> Daily Suction Piping mgnitoring f23CCR App, IV <br /> Pipincr Tightness Test 23CCR 2643 b c d <br /> Gravity Piping Tested Every 2 Years [23CCR 2643 (e) ] <br /> Monthly Line Test J23CCR 2643 c 2 <br /> Annual earc Detecto <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Removed, Closed or Temporar y Closed 23CCR 2670 <br /> REHS INSPECTION DATE/TYPE: <br /> RECEIVED BY: PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGEof <br /> PHS 231(M) <br />