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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 �"(U//ST) PROGRAM INSPECTION REPORT <br />Facility Name C�Y`�.V i(+rogram ID# 7_/ f 7 <br />Facility Address <� City G Zip Me <br />UST: Dual Wall S' gle Wa OVERFILL: Audible Visualanical <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 />UST GENERAL REQUIREMENTS <br />Permit to Operate [H&SC 252841 <br />Forms A & B Current LH&SC 25284 c <br />monitoring/maintenance Records 23CCR 2712 b <br />Financial Responsibility rH&SC 2q292-2(a)l <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 spill on ainer <br />Pprmittpd UST Repairs [21rCR 29611 <br />Cathodic Protection 23CCR 2635 a 2 A <br />New USTs Monitored Continuously [23CCR 2630] <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />Meters Calibrated [23CCR i <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -Variation Procecture Followed L23CCR-2r9T97-e-)j <br />STA'ISTTCAL 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 />Daily Stick Reading c <br />AUT )MATTC! TANK QAUQTNQ- (ATG) <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 Tankn egri y Test <br />lanx Gauging Procedure o owe <br />Daily Suction Piping Monitoring r2 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 L23CCR 2643 c 2 <br />nu Detector <br />TANK REMOVAL <br />Permit to Close or Cease Operation H&SC 25298 <br />Removed, sedypr Tempo r y Closed 23CCR 2670 <br />REHS // V .A'-✓ INSPECTION DATE/TYPE: X3-50 <br />RECEIVED BY: PHONE: <br />Revised Date 7/1 /97 23 CCR UST Regs May 5, 1994 PAGE_/_of <br />PHS 260 (4/98) <br />