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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 /> Facility Name Program ID# <br /> Facility Address City Zip <br /> UST: Dual wall Single Wall OVERFILL: AudibleLVisual�Mechanical <br /> PIPING SYSTEM: al wall Single wall Suction Pressure Gravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23C-E-R-2636 (g) requirementsVI�LAO <br /> TIONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&SC 25284] <br /> Forms A—& B Current H&SC 25284 c <br /> Monitorin Maintenance Records 23CCR42712 (b)Monitorin Records Available 23CCR 2 <br /> Monitorin Plan (23CCR 2632 (d) (1) <br /> Eesnonqp Plan r2'1QCR 2632 (d) (2) 1 <br /> Unauthorized Releases Reported [H&SC 25295] <br /> Monitoring Equipment Annuai Cert. L23CCR 2630 <br /> Over spili Container <br /> Pprmittpd TIparar3ps, r2-3r-ZR 96601 <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 2630] <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Meters brated r23CCR 2 4 i <br /> Monthly Variations Calculated 123CCR 2646 (d) ] <br /> EX-Variation roce ure FolloweeTJ <br /> STATISTICAL INVENTORY RECONCTLTATIgN (SIB) <br /> Inconclusive Procedure Followed [23CCR 2646.1 (d) ] <br /> UST Integrity Test Ever Two Years 23CCR 2646.1 <br /> Annual SIR Report 123CCR 2646.1 (j) ] <br /> ai y Stick Reaciff-ig- c <br /> AUTOM611c! TANK GAT7QTNQ (ATM) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> nuaSummary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annuai Ianxn egri y rest <br /> Tank uauqing ProcecTure Foiloweci <br /> I <br /> Daily Suction pipinq Monitpring r23CQR A .I <br /> Piping Tightness Test 23CCR 2643 b c d <br /> Gravit Pi ing Tested Every 2 Years [23CCR 2643 (e) ] <br /> Monthly Line Test 23CCR 2Z43 (c 2 <br /> Annue o <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Removed, Closed or Temporar y Closed 23CCR 2.670 <br /> REH INS CTION DATE/TYPE: <br /> RECEIVED BY PHONE: <br /> Revised Date /15/97 23 CCR UST Regs May 5, 1994 PAGE�of <br />