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PUBLIC HEALTH SERVICES SAN <br />ENVIRONMENTAL HEALTH <br />304 E. Weber Ave., Third Floor, <br />(209) 468-3420 <br />JOAQUIN COUNTY <br />DIVISION <br />Stockton, CA 95202 <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility Name L4vor-1111 —Program ID# -7--,S <br />Facility Address_ rfkr"'�k city 1 zip <br />UST: Dual Wall_L/' Single OVERFILL: Audible Visual Mecbohical <br />-Y'Single wall Suction Pressure <br />PIPING SYSTEM: Dual wall Gra;:'ty <br />DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636(8) requirements? YES NO <br />VIOLATIONS <br />'r'A <br />UST GENERAL REQUIREMENTS <br />Permit to Operate [H&SC 25284] <br />Forms A & B Current LH&SC 251, 84(b)(c I <br />Monitorin Maintenance Records [23CCR 2712(b)l <br />Finannial Resnnnnibility rT4rSC <br />Monitoring Records Available [23CCR 2712] <br />Monitoring Plan [23CCR 2632(d)(1)] <br />R-qn nse P an MCCR 2632(d)(2)] <br />Unauthorized Releases Reported [H&SC 25295] <br />-Monitoring Equipment Annual Cert. 23CCR 2630(d)T—' <br />11 Container 123CC. <br />PArmitt-AH UST RAnairn r2l(IrP 26611 <br />-P==ilted Uparades r9ArrT? 9s;s;n1 <br />Cathodic Protection [23CCR 2635(a)(2)(AU­ <br />New USTs Monitored Continuously [23CCR 2630] <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />-IMI Ilategxi 1 111 - . I ------- <br />ii=1 MT Report <br />Meters Calibrated Laj=­2�46(j)] <br />Dalliz Stick Readi-cz [23CCR 2GArN I-) <br />ancrincr Stick in I R Tnnhpn r23C!CR 2946(nl (1) (T?.)L_ <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Rx-Varia Eion *"'Proc-e-du­re Foilowea [23CCR-264C(e)j <br />inconclusive Procedure Followed [23CCR <br />UST Integrity Test -Every Two Years [23CCR 2646.1E= <br />Annual SIR Report [23CCR 2646.1(j)) <br />Daily is Reading L23CCR--2-646 Cc) (I)j <br />A=9= a (ATal <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />==uaI ATG S-u—mmary Report L2-SCCR--2712-(b)-T2TT— <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly —[23CCR 2645(b)] <br />Annual TanK integrity Tefft-J-Z3UX 2645kD)i <br />an Gauging Proceaure-7FoTj-owe <br />cL ;eb4b tCln <br />RTNa - J <br />ailv Suction Piping Monitoring r23CCR Ant),II1 <br />Pi in Ticrhtness Test [23CCR 2643(bc),Wl <br />GravitX Piping Tested Every 2 Years (23CCR-2643 (e)] <br />Monthly Line Test [23CCR —2643(c)(2TT— <br />MMUNI LeNK Dergcr5-f--Tggt: [23CCK 2bJUta)i <br />TANK REMOVAL <br />Permit to Close or Cease Operation [H&SC 252981' <br />Removedj,--Clo <br />A 'fed 5*-Te—mp6ra-r-I-y---C-Iosed-[23CC-R�7O� <br />INSPECTION DATE/TYPE: 117,bA5oV <br />RE TVE!D v <br />BY: � C �,a, t, Vr7 f0, <br />PHONE: <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE <br />of <br />PHS 280 (4/98) <br />