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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 1 � ( l SJ��), cProgram IfD#_� <br /> Facility Address cx�C + ,7. City -S-'-toA`74r' zip <br /> UST: Dual Wall Single Wall OVE LL: Audible Visual_ echanical <br /> - <br /> PIPING SYSTEM: u 1 wall_X_Single wall Suction PressureGravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (g) 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 25284 c <br /> Monitoring/Maintenance Records 23CCR 2712 (b) ] <br /> Monitoring Records Available 23CCR 2712 <br /> Monitoring Plan 23CCR 2632 (d) (1) ] <br /> Resiponse Plan F23CCR 2632 (d) (2) 1 <br /> Unauthorized Releases Reported [H&SC 25295] <br /> Monitoring Equipment Annual Cert. 23CCR 2630 <br /> ver siDiii ConF-a--iner [23CCR 777755) j <br /> Pprmit-t-f-d UST Rpnairs [23=R 26(;11 <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 26301 <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Meters r 23CCR 2646 (1) 1 <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-variation Procecture o owe e <br /> STA 'ISTICAL 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 /> AUTO GAUGING (ATG) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> nua ummary epor <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annual lankn egri y Test <br /> Tank auging Proceciure oiiowecl <br /> PING MONITORING <br /> Daily Suction Pivincr Monitoring r2 R ADD. 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 2643Tc–TT2–TT-- <br /> Annual EeaXDetector lest <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Removed, Closed or Temporar y Closed 23CCR 2670 <br /> r i <br /> REHS G C; INSPECTION DATE/TYPE: % _, "C) _ C ,� <br /> RECEIVED BY:— /'1i/1 ^-1 PHONE: ( Z M � Cj y -G�j h t - <br /> Revised Date 7/15/97 3 CCR UST Regs May 5, 1994 PAGE__L_of <br /> PHS 260 (4/98) <br />