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­ 1 0 <br />PUBLIC HEALTH SERVICES SAN <br />ENVIRONMENTAL HEALTH <br />304 E. Weber Ave., Third Floor, <br />(209) 468-3420 <br />L] <br />JOAQUIN COUNTY <br />DIVISION <br />Stockton, CA 95202 <br />UNDERGO TO GE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility Name. Program ID# <br />Facility Address /.,nalc City- =S �' _Zip <br />UST: Dual Wall V Single Wa OVERFILL: Audible Visual_Me <br />f?� ca <br />S: <br />PIPING SYSTEM: Dual <br />I wall Single wall Suction Pressure— Gravity <br />S STEM <br />DOES THE LEAK DETECTION S STEM meet 23CCR 2636(g) requirements? YES NO <br />VIOLATIONS <br />UST GENERAL REQUIREMENTS <br />Permit to operate [H&SC 25284] <br />Forms A& B Current [H&SC 25284 cA <br />Monitorincr/Maintenance Records r23CCR 2712(b)l F <br />FinanniAj, EgapoUgjlilitv rT;&sr 2c;7c)2.2(a)1 <br />Monitoring Records Available _[23CCR 2712] <br />Monitoring Plan [23CCR 2632(d)(1)] <br />Rasnnr) se P an 2-ACCR 2632(d)(2)] <br />Unauthorized Releases Reported [H&SC 25295] <br />Monitoring Equipment Annual Cert. 23CCR 2630(dTT— <br />ver s aLl ConEainer L23CCR 2635Tblj <br />Ra=jtted UST Rpnairs r2iccR 26ell <br />Rermitted TT---.qeies [23Cr-'P "r- ()l <br />Cathodic Protection [23CCR 2635(a)(2)(A)] <br />New USTs Monitored Continuously [23CCR 2630] <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />- agrity Test - -- 4'A 1 <br />-Annual MIR Rej=rt [23CCR 2649-(crl I <br />Mgr.�,,rs Calibrated r23(!C7R 26,16iLj <br />Daj I NT Qf-i -I- P== A i nrT r,;ozrrp I r�46 I r) (1 1 1 <br />Gauging Sti-t-k in 1 Ze Inches r2-,irrp 9646 (Q) (3) (E) I <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -Variation Proceffu-re FoIloweEl [23CCR 264F)(e)j <br />(STRI <br />Inconclusive Procedure Followed [23CCR 2646.1(d)] <br />UST Integrity TestEverTwo Years [23CCR 2646.1(g)l <br />Annual SIR Report [23CCR 2646.1(j)] <br />Daiiy Stick-R-e-a-di—ng [23CCR 2646 (c)(1) <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />M I -f7&m (ATal <br />MOUNI ATG Summary ReporE L23CCR-Z= Cb�� <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />=uai Tank integrity Test L23CUR 2b4b tJO) 1 <br />an Gauging Procs clur-e--Yo-llowe <br />�d--IziL:ux 264bTff= T— <br />:tion Pinina Monitoring r23CCR_ApNjU . ..... <br />Piping Tightness Test [23CCR 2643jb),(c),(d)j <br />Gravity Piping Tested Every 2 Years [23CCR2643(e)] <br />Monthly Line Test23CCR2643 (c) (2)] <br />AMUNI r9ax Def�F=r 'lest (23CCR 263U (a) j <br />TANK REMOVAL <br />Permit to Close or Cease Operation �C 25298] <br />Remove , P-0- !3CCR 2670] <br />Clo rarl; <br />I I EEL <br />REHS IN,%4tTION DATE/TYPE: 71J15-1qA /Ycr—jLN� <br />RECEIVED BY: PHONE: V <br />Revised Dat 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of_2,,--- <br />PHS 260 (4/98) <br />