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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 /> w � <br /> Facility Name �PP Program ID# <br /> Facility Address `j)c0 Cit City zip <br /> UST: Dual Wall Single Wall OVER F L :Audible Visual_Mechanical <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 LH&SC 25284 c <br /> monitoring/Maintenance Records 23CCR 2712 (b) ] <br /> Monitoring Records Available 23CCR 2712 <br /> monitoring Plan [23CCR 2632 (d) (1) ] <br /> Resnonse Plan r23CCR 2632 (d) (2) 1 <br /> Unauthorized Releases Reported [H&SC 252951 <br /> Monitoring Equipment Annual Cert. L23CCR 2630 <br /> Over spill on ainer L23CCR 2635 (b) ] <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 2630] <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> meters li r 2 4 <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-Variation Proceaure ieoilowecl L23CCH 2b4b (e) j <br /> T !STICAL INVENTORY- RECONCILIATION (SIR) <br /> Inconclusive Procedure Followed [23CCR 2646.1(d) ] <br /> UST Integrity Test Every Two Years 23CCR 2646. <br /> Annual SIR Report [23CCR 2646.1(j) ] <br /> Daily Stick Reading c <br /> AUTOMATIC TANK GAUGING (ATG) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annual Summary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annual an n egri y Iest <br /> Ianx Gauging Proceaure koliowea <br /> Daily i n Pipincr M ni r'n 2 R A .II <br /> Piping Tightness Test 123CCR Z643 b c d <br /> Gravity Piping Tested Every 4 Years [23CCR 2643 (e) ] <br /> Monthly Line Test L23CCR 264 c 2 <br /> Annuai <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Removed, Closed or Temporar y Closed 23CCR 2670 <br /> REHS ' INSPECTION DATE/TYPE-3/3/ <br /> 5 , <br /> RECEIVED BY: PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br /> PHS 231(9/97) <br />