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Ll <br />PUBLIC HEALTH SERVICES SAN <br />ENVIRONMENTAL HEALTH <br />304 E. Weber Ave., Third Floor, <br />(209) 468-3420 <br />N <br />JOAQUIN COUNTY <br />DIVISION <br />Stockton, CA 95202 <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility NamePl� FgA� Program ID# <br />Facility Address ;' Vhf.on <br />City Zip <br />UST: Dual Wall Single Wal OVERFILL: Audible Visual_ Mechanical <br />PIPING SYSTEM: Dual wall Single wall Suction Pressure Gravity <br />DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636(g) requirements? YES NO--- <br />VIOLATIONS <br />UST GENERAL RE UIREMENTS TALAR # <br />Permit to Operate [H&SC 252841 <br />Forms A& B Current [H&SC 252 4 c <br />monitoring/Maintenance Records F23CCR 2712 b <br />Monitoring Records Available 23CCR 2712 <br />Monitoring Plan 23CCR 2632(d)(1)] <br />Response Plan f23CCR 2632(d)(2)1 <br />Unauthorized Releases Reported [H&SC 25295] <br />Monitoring Equipment Annual Cert. 23CCR 2630 <br />over s i on ai.ner <br />Cathodic Protection 23CCR 2635 a 2 A <br />New USTs Monitored Continuously [23CCR 26301 <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />Meters Calibrated r23cCR 2646(i)l <br />Gauging Stick in 1?8 Inches r23CCR :2946(c)(1)(F)l <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -Variation Proceaure Followed L23CCR 2646(e)j- <br />STATISTICAL <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)] <br />Daily Stick Reading c <br />AUT)MATIC TANK GAUGING (ATG) <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />Annual ATU Summary epor <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />Annual rankn egri y Test <br />Tank auging Proceaure kollowed <br />DailyPIPING MONTTORTNG <br />in M n' r' [23CCR ADD.II1 <br />Piping Tightness Test 23CCR 2643 b c d <br />Gravity Piping Tested Every 2 Years [23CCR-2643(e)] <br />Monthly Line Test 23CCR 2643 c 2 <br />u r <br />TANK REMOVAL <br />Permit to Close or Cease Operation H&SC 25298 <br />Removed, Closed or Temporar y Closed 23CCR 2670 <br />XEHS UAJMN M INSPECTION DATE/TYPE:.Y;�U qU 1)-�t <br />RECEIVED BY: PHONE: 4�/ <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE I of G <br />PHS 260 (4/98) 6 <br />