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PUBLQ HEALTH SERVICES SAN JOAQ 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, �� / / '� Program ID# <br /> Facility Address City �;.'C Zip ` <br /> fU `t� ES ~ <br /> UST: Dual Wall" Single Wall OVERFILL: Audible Visual_Mechanical <br /> PIPING SYSTEM: Dual wall Single wallSuction—X-Pressure Gravity <br /> DOSS THE' LEAK DETECTION SYSTEM meet 23CC . 2636 (g) requirements? YES NO� I <br /> VIOLATIONS M <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to 22erate [H&SC 252841 ! <br /> Forms A & B Current H&SC 25284 c f <br /> Monitorin Maintenance Records r23CCR 2712 b : 1 <br /> Ziaaagial Responsibility rHF,-9C 25299 ? (a) l.' <br /> Monitoring Records Available 23CCR .2712 <br /> Monitoring Plan [23CCR 2632 (d) (1) J <br /> Unauthorized Releases Reported [H&SC 252951 <br /> Monitoring Equipment Annuai Cert. 23CCR 2630 <br /> ver s s Container f <br /> r <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 2630] <br /> MANUAL INVENTORY RECONCILIATION (MIR) . Q <br /> + I <br /> Meters Calibrated r23CCR 2646 (i) l <br /> Monthly Variations Calculated [23CCR 2646.(d) ].- <br /> x- aria ion Procedure Foilowee) l <br /> t <br /> STATISTI !AL INVENTO RECONCILIATION (SIR) <br /> Inconclusive Procedure Followed [23CCR 2646. 1(d) ] <br /> UST_Integrity Test Every Two Years 23CCR 2646.1 t <br /> Annual SIR Report [23CCR 2646.1 (j) ] j <br /> Dally sticR ReaHing c <br /> AUTOMATIC XG (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 /> Annual a Integrity Test <br /> Tanx Uaugingroce ure o owe s <br /> Daily Suction Pining it <br /> PiRing Tightness Test 23CCR 2643 b c d L <br /> Gravity Piping Tested Every 2 Years .[23CCR- 2643 (e) ] <br /> Monthly Line Test L23CCR 2643 777-277- <br /> Annual IMAM Detector <br /> TANK REMOVAL 1 <br /> Permit to Close or Cease Operation H&SC 25298-7— <br /> Removed, <br /> 5298Remove , Z21osed or Temporar y Closed 23CCR 2 70 ; <br /> REHS Letj 7 1(ti P 1 -s-7 INSPECTION DATE/=E: <br /> RECEIVED BY: PHONE: -1 <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br /> PNS 231 (9/97) I <br /> i <br />