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PUBLI HEALTH SERVICES SAN JOAQU "BOUNTY <br />ENVIRONMENTAL HEALTH DIVISION <br />304 E. Weber Ave., Third Floor, Stockton, CA 95202 <br />(209) 468-3420 <br />STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility Name <br />p1�Tc� Program ID# <br />Facility Address_1 �130� - City <br />f4& - Zip <br />UST: <br />Dual Wall Single Wall _OVERFILL: Audible Visual_ Mechanical <br />PIPING SYSTEM: Dual wall Single wallX SuctionPressure Gravity <br />DOES THE LEAK DETECTION SYSTEM meet 23CCR 2`636(g) requirements? YES NO <br />VIOLATIONS T <br />-KAM& if .. <br />UST GENERAL REQUIREMENTS <br />Permit to Operate [H&SC 252841 <br />Forms A & B urrent & C 25284 c <br />Monitoring/maintenance Records 23CCR 2712 b <br />Monitoring Records Available 23CCR 2712 <br />Monitoring Plan [23CCR 2632 (d) (1) <br />Response Plan r23CCR 2632(d)(2)1 <br />Unauthorized Releases Reported [H&SC 25295] <br />Monitoring Equipment Annual Cert. 23CCR 2630 <br />over spill on ai.ner <br />Cathodic Protection 23CCR 2635 a 2 A <br />New USTs Monitored Continuously [23CCR 26301 <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />M t <br />i <br />Monthly Variations Calculated [23CCR 2646(d)] ; <br />x- ar a ion Procedure Followed L23CCH 2646(e)j <br />STATISTICAL 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)] t <br />Daily Stick Reading (cOMATIC TANK GAUGING (ATQ))(1)i <br />t <br />Monthly ATG Results [23CCR 2643(b)(1)] t <br />Annual ATU 6ummary Report <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />Annual Tankn egri y Iest <br />I'anx GaugingProcedure Followed <br />PIPING MONITORTNr, <br />Daily u i n Piping monitoring r23CCR Aipp.II1 <br />Piping Tightness Test 23CCR 2643 b c d 1 <br />Gravity Piping Tested Every 2 Years [23CCR 2643(e)] ) <br />Monthly Line Test 23CCR 2643 c 2 t <br />Annual <br />TANK REMOVAL <br />Permit to Close or Cease Operation H&SC 25298 <br />Removed, Closed or Temporarly Closed 23CCR 2670 <br />REHS V ./ ,!� INSPECTION DATE/TYPE: %/i e `J'Y�1 <br />RECEIVED BY: PHONE: <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of y <br />PHS 231 (9/977) <br />