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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 �nL [ ) Program ID# <br /> Facility Address I-Sri City Zip C'f <br /> UST: Dual Wall Single Wall OVERFILL: Audible VisualMechanical _ <br /> PIPING SYSTEM: Dual wall_,,),"_Single wall Suction Pressure Gravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 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 TH&sc 25284 c <br /> Monitoring/Maintenance Records 23CCR 2712 b <br /> Monitoring Records Available 23CCR 2712 <br /> Monitoring Plan [23CCR 2632 (d) (1) ] <br /> Response Plan [23CCR 2632 (d) (2) 1 <br /> Unauthorized Releases Reported [H&SC 25295] <br /> Monitoring Equipment Annual Cert. 23CCR 2630 <br /> Over spiii Container <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 2630] <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> UST Tnt�-aritv T <br /> Meters r 2 R 2 4 i <br /> 1 <br /> Gaucrina stick in 1A Inches [23CCR 2646 (c) (1) (F) l <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-Variation Proceaure Fo115wec77=77 :?b4b (e) j <br /> STATISTICAL 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 GAUGING (ATG) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annuai A= Summary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annuai Tankn egri y fest L23CUR 264b �JD) j <br /> iank Gauging Proceciure PoiiowecL <br /> PIPING MONITORING <br /> Daily u n Piping monitorincr r23CCR Avv. III <br /> Piping Tightness Test 23CCR 2643 b c d <br /> Gravity Piping Tested Every 2 Years [23CCR 2643 (e) ] <br /> Monthly Line Test 23CCR 2643 c 2 <br /> Annuai EeaK DeteCtor <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Removed, closed or Temporar y Closed 23CCR 2670 <br /> REHS - li j3/{fid INSPECTION DATE/TYPE: <br /> RECEIV D BY: Rly ✓/ PHONE: <br /> Revised Date 7 15/97 23 CCR UST Regs May 5, 1994 PAGE of <br /> PHS 260 (4/98) <br />