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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 TPINK (UST) PROGRAM INSPECTION REPORT <br />Facility Name1� Program ID# 7 <br />Facility Address City zip <br />UST: Dual Wall S�gleWa OVERF LL: Audible VisualMec nicalPIPING SYSTEM:Dual wall p- wall Suction Pressure Gravity <br />DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636(8) requirements? YES NO� <br />VIOLATIONS <br />UST GENERAL REQUIREMENTS tt <br />Permit to Operate [H&SC 252841 <br />Forms A & B Current H&SC 25284 c <br />Monitoring/Maintenance Records r23CCR 2712 b <br />Financial Responsibility FT4&SC 21;292 2 (a) 1 <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 />ver svill Container <br />1 <br />Cathodic Protection 23CCR 2635 a 2 A <br />New USTs Monitored Continuously [23CCR 2630] <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />UST Tntparitv Tf:-qt [23CCR 2.643-11 <br />Meters Calibrated [23CCR 264 6(1)1 <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -variation Procedure oliowed L23CCR 2646(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 />AUT MATIC TANK GAUGING (ATG) <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />Annuai ATG Summary Report <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />nuai 'rank integrity es <br />'I'ank Gauging Proceclure Foliowea <br />PTPTNQ MONITORING. <br />Daily Suction Piping monitoring f2 R ADD.II1 <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-TT27T- <br />Annuai EeaR Defector <br />TANK REMOVAL <br />Permit to Close or Cease Operation H&SC 25298 <br />Removed, Ciosed fr Tempo r y Closed 23CCR 2670 <br />REHS r(IV&4(�/ INSPECTION DATE/TYPE: <br />RECEIVED BY: PHONE: <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE__Lof <br />PHS 260 (4/98) <br />