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Nwe ow <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 /> UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br /> Facility Name Program ID# <br /> Facility Address /`}/� ytrS�-n�.� City (,�„� Zip <br /> UST: Dual Wall in a Waw OVERFILL: Audible Visual Mechanical <br /> PIPING SYSTEM: Dual wall Single wall Suction Pressurer"Gravity <br /> DOHS THE LEAK DETECTION SYSTEM meet 23CCR 2636 (g) requirements? YES NO�C <br /> VIOLATIONS <br /> UST TANK # <br /> GENERAL R8 UIRBMHNTS <br /> q] <br /> Permit to Operate [H&SC 252841 <br /> Forms A & B Current LH&SC 25 84 c <br /> Monitorin Maintenance Records 123CCR 2712 b <br /> Monitorina Records Available 123CCR 2712 <br /> Monitorin Plan 23CCR 2632 (d (1) <br /> Unauthorized Releases Re orteL23CCR 26 <br /> d [H&SC 25295] <br /> Monitoring Equipment Annua Cert. 23CCR 2630 <br /> ver spill container <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTS Monitored Continuously [23CCR 2630] <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> UST Tntpg�ity Test 191(�rP '>94 <br /> Meters Calibrated F23CCR 2646 (i) l <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-variation Procedure Followe7eTT— <br /> STATISTICAL <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 /> 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 /> Annual an n egri y lest <br /> eb4b �D) T- <br /> Uank Gaugingroce ure koll6wea <br /> MONTTORTNG <br /> Daily Suction Pilping M <br /> Piping Tightness Test 123CCR 2643 b c d <br /> Gravit Pi in Tested Ever 2 Years [23CCR 2643 (e) ] <br /> Mont y Line Test 23CCR 2643 c2 <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 252981— <br /> Removed, flosed or Temporar y Closed 23 R 2670j <br /> REHS INSPECTION DATE/TYPE: <br /> RECEIVED BY: PHONE: SJF 4v6 <br /> Revised Date 7/15/97 23 CCR UST Reg May 5, 1994 PAGE�of7 <br /> PHS 260 (496) �` <br />