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0 0 <br /> 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 /> UNDERGRO STORAGE TANK <br /> /(UST) PROGRAM INSPECTION REPORT <br /> Facility Name ? //�,, // P� / ogram ID# <br /> Facility Address �� / ✓, //���� City !� ip <br /> UST: Dual Wall Single Wali OVERFILL: Audible .,�Visual _�'Mechanical <br /> PIPING SYSTEM: Dual wall�ingle wall Suction Pressureravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (g) requirements? ES,�' NO <br /> VIOLATIONS <br /> TANK # <br /> VST GENERAL REQUIREMENTS 777F-M <br /> Permit to Operate [H&SC 25284] <br /> Forms A & B Current LH&SC 25 4 c <br /> monitoring/maintenance Records r23CCR 2712 b <br /> Monitoring Records Available 23CCR 2712 <br /> Monitoring Plan 23CCR 2632 (d) (1) ] <br /> Resnonse Plan [23CCR 2632 (d) (2) ] <br /> Unauthorized Releases Re orted [H&SC 252951 <br /> Monitoring Equipment Annua Cert. L23CUR 2630 <br /> ver spill on ainer <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 2630] <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Meters Calibrated r23CCR 2646 (i) l <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-Variation Procedure Followed L23CUR 2b4b (e) j <br /> _Aj&Tj2ZLC&L 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 /> AUTOMATIC TANK QAT7QTNQ (ATG) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annual AEG summary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annual lankn egri y lest <br /> ianic Gauging Proceaure o owe <br /> PIPING MONITORING <br /> Daily Suction Pir)ing Monitoring f23CCR Aipip.II <br /> Piping Tightness Test 23CCR 2643 b c d <br /> —G a <br /> it Pi in Tested Ever 2 Years [23CCR2643 (e) ] <br /> Mont y Line Test 23CCR 2643 c 2 <br /> Annuai <br /> TANK REMOVAL <br /> Permit to C ose or Cease Operation H&SC 25298 <br /> Removed/71osed or Temporar y Closed 23CCR 2670 <br /> REHS INS ECT ION DATE/TYPE: <br /> RECEIVED BY: PHONE: 0?0 /p o79"2 IP2CJ/� <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br /> PHS 260 (4/96) <br />