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PUBLI(PHEALTH SERVICES SAN JOAQU#1COUNT <br />ENVIRONMENTAL HEALTH DIVISION <br />304 E. Weber Ave., Third Floor, Stockton, CA 952 <br />(209) 468-3420 1 <br />Facility Name(D 11 A 41wn Program ID# -A 3 <br />j - - 1 <br />Facility Address c)30 - 01i v -e, City zip <br />UST: Dual Wall Single Wall >< OVERFILL: Audible Visual Mechanical <br />PIPING SYSTEM: Dual wall Single wall X SuctionPressure Gravity_ <br />DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636(8) requirements? YES NO <br />VIOLATIONS <br />UST GENERAL REQUIREMENTS <br />Permit to Operate (H&SC 252841 <br />Ma M f P I k *lei <br />IM 0 lwvff�� 1: <br />Monitor "n-Re—cords Available [23CCR 27121 <br />W '72wwu I <br />= ZT41 010) 0 TIM 0 WEV-4m 90*TQ44 1qWT1kPAr* IN <br />Unauthorized Releases Reported [H&SC 25295] <br />MON <br />Cathodic Protection [23CCR 2635(a)(2)(A)l <br />New USTs Monitored Continuously [23CCR 26301 <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />WSAYMMeM,1� <br />WATA�.- <br />-Meters Calibrated r W Iirr <br />•win. <br />monthly Variations Calculated [23CCR 2646(d)] <br />0 . 0 0 - 0 T - OWIV*1414) VZC32 <br />*V101"MU1101- 1Mk*R4*i*R["*F#*Ni <br />Inconclusive Procedure Followed [23CCR 2646.1(d)] <br />Annual SIR Report (23CCR 2646.1(j)] <br />D=i y=c� Reading L23CCR 2646 (c) <br />fjo OQ <br />Monthly ATG Results (23CCR 2643(b)(1)] 1� MR <br />Annual ATG summary Report L23CCR 2712(b)(2)j <br />MANUAL UST TANK GAUGING (KTG) I MM am <br />Tank Gauging Weekly [23CCR 2645(b)] <br />-mun-u-a-r-rank integrity Test Lz.3uux <br />• <br />I WM ME <br />ilailv Suction PiDincr--Mortitorinq—E23C-CR-Ar)D.I-11— lw—�=M <br />0 13 , x = * -- I -- 2 F V E F -Z I M 02 re W. -I W. <br />EVRIWAVAFAW- <br />Monthly Line Test L23CCR 2643(c)(2)] <br />Permit to Close or -Cease Operation [H&SC 252981 <br />R ��emo v e, Closed or Temporarly Closed [23CCR <br />J q I f <br />RECEIVED BY: PHONE: <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE -I-- of <br />PHS 231 (9/97) <br />