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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 /> r� <br /> Facility Name f `<_C� Program ID# <br /> Facility Address ��L z %� City ee, Yui zip <br /> UST: Dual Wall Single Wall OVERFILL• Audible VistialMechanical <br /> PIPING SYSTEM: Dual wall Single wa11,eo�Suction Pressure Gravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (8) requirements? YES NO <br /> VIOLATIONS <br /> UST GENERAL REQUIREMENTS TANK # <br /> Permit to Operate [H&SC 25284] <br /> Forms A & B Current H&SC 25284 c <br /> Monitoring/Maintenance Records [23CCR 2712 (b) l <br /> Monitoring Records Available 23CCR 2712 <br /> Monitoring Plan [23CCR 2632 (d) (1) ] <br /> Resnonse Plan [23CCR 2632 (d) (2) ] <br /> Unauthorized Releases Reported [H&SC 25295] <br /> Monitoring Equipment Annual Cert. 23CCR 2630 <br /> ver s i on alner [23CCR 2635 (b) ] <br /> Permitted UST Renairs f2l= 26611 <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 2630] <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Meters Calibrated F23CCR i <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-Variation Procedure oiiowed [23CCR 2b4b (e) j <br /> STArISTICAL 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 GAUGING (ATG) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annuai ATU Summary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> nuai 'rank integrity iest <br /> lank Uauging Procecture oiiowea <br /> Daily Suction Piping monitoring [2 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 /> Annual <br /> TANK REM VAL <br /> Permit-11D Clos r Cease Operation H&SC 25298 <br /> Remo v �iosrd.,� TemporarEyClosed23CCR 2670 <br /> REHS INSPECTION DATE/TYPE: 7 <br /> --- <br /> -7T-/ <br /> 411,T <br /> RECEIVED BY: / PHONE:—'-' '' <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br /> PHS 260 (4/98) <br />