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10 <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 /> Facility Name -}-- Program ID# <br /> Facility Address �J 21"] nni city zip <br /> UST: Dual wall Single wall--_6 OVER ILL: Audible Visual Mechanical <br /> PIPING SYSTEM: Dual wall_Sngle wall Suction_Pressure Gravity <br /> DOES THE LEAK DHTBCTION SYSTBM meet CR 2636 (8) requirements? YES NO <br /> VIOLATIONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&SC 252841 <br /> Forms A & B Current H&SC 25 4 c <br /> Monitoring/Maintenance Records 23CCR 2712 b <br /> Monitoring Records Available 23CCR 2712 <br /> Monitoring Plan 23CCR 2632 (d) (i) <br /> Resnonse Plan r2l(!C!R 2632 (d) (2) 1 <br /> Unauthorized Releases Re 0rted [H&SC 252951 <br /> Monitoring Equipment Annus Cert. L2.icux 2630 <br /> Over siDiii conFa—iner <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 26301 <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Meters 2 4 <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> x- ar a ion Procedure Followed L=CR 2646 (e) j <br /> STATISTICAL INVENTORY RECONCILIAT (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 GAUGING (ATQ) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annual ummary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annual a n egri y iest <br /> lank UaugingProcedure Followed <br /> PIPING MONI <br /> Daily Suction Piping 2 R APP. III <br /> Piping Tightness Test 123CCR 2643 b c d <br /> Gravit Pi in Tested Ever 2 Years 123CCR 2643 (e) ] <br /> MontHy Line Test 23CCR 2643 c 2 <br /> annuai Leak <br /> TANK REMOVAL <br /> Pe t to Close or Cease Operation H&SC 25298 <br /> emov ose or Temporar y Closed L23CCR 2670 <br /> REHS INSPECTION DATE/TYPE: <br /> RECEIVED BY: PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGEr�- of <br /> PHS 231("7) <br />