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PUBLIPHEEALTH SERVICES SAN JOA4UI1000UNTY <br />ENVIRONMENTAL HEALTH DIVISION <br />304 E. Weber Ave., Third Floor, Stockton, CA 95202 <br />(209) 468-3420 <br />UNDERGRRUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility Name <br />141/j <br />1, _Pyogram ID# <br />Facility Address4,2 lar T-6� n6w City zip <br />UST: Dual Wall -e Wall: RFILL: 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 />VIOLA7T--1ONS <br />UST GENERAL REQUIREMENTS <br />Permit to Operate [H&SC 252841 <br />Monitoring Records Available [23CCR 2712] <br />.. .. ; iii <br />It ft -7-5 WN <br />Cathodic Protection [23CCR 2635(a)(2)(A)l <br />New USTs Monitored Continuously [23CCR 2630] <br />,LeterB-Cal-ibrated 123CCR-2646(i)l <br />Rajiq�-uwg Stigk :La1�8 Iw.ches-- (c) (1) (E 11 <br />Monthly Variations Calculated [23CCR 2646(d)]-�; <br />Ex -variation Procedure Foiiowed L23CCR 2646(e)j <br />STATISTI-CkL (SXv.) <br />1111!1111 111111 mi!g�;:�� <br />MuLamm zlmsm- <br />Annual SIR Repoi-t (23CCR 2646.1(j)] <br />Daiiy Stick Reading L23CCR 2646 (c) <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />Annual AM Summary Report L23CCR 2712--(b)(2)j <br />, =1� <br />Tank Gauging Weekly [23CCR 2645(b)] <br />-7ffffi-uaj-T-anK integrity 'rest L23CCR 2645tJ0)j <br />:lion <br />Dailv Suction PiDina Monit-or-i- 123CCR Apr).111 � NUMM"Mal <br />Pi ing Tightness Test [23CCR 2643(b),(c),(d)] -IMIPAIW&%TA�l <br />• <br />Gravit Pi ing Tested Every 2 Years [23CCR-.-2643(e)] umv <br />Monthly Line Test (23CCR 2643(c)(2)1-- <br />0 <br />Permit to Cl-ose or Cease Operation [H&SC 252981 <br />Closed or Tem�•rar-Ly--Closed [23CCR 2670] <br />REHS (I 6� _INSPECTION DATE/TYPE: <br />RECEIVED BY: PHONE: <br />Revised Date 7/1W7 b17 23 CCR UST Regs May 5, 1994 PAGEof <br />PHS 239 (9/97) <br />