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PUBLIC HEALTH SERVICES SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E. Weber Ave. , Third Floor, Stockton, CA 95202 <br /> (209) 468-3420 <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br /> Facility Name Program ID# 74 <br /> Facility Addresscity zip <br /> UST: Dual Wall Angle Wa- l OVERFILL: Audible Visual —Mes�an]cal <br /> Suction Press :, - ,,-- <br /> PIPING SYSTEM: Dual wall Single wall Pressure <br /> L,� Gravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (g) requirements'. YES NO <br /> VIOLAT`IONS <br /> UST GENERAL REQUIREMENTS TANK # <br /> Permit to Operate [H&SC 25284] <br /> Forms A & B Current LH&S 25284-Cbj-FcTT <br /> Monitorin Maintenance Records [23CCR 2712 (b) ] <br /> Financial ReRnnnnihility mrgSC 29292-2 (a) ] <br /> Monitoria_q Records Available [23CCR 27121 <br /> Monitoring Plan [23CCR 2632 (d) 1) ] <br /> ResponRA Plan r23C!(R 2632 (d) (211 <br /> Unauthorized Releases Reported [H&SC 25295] <br /> Monitoring Equipment Annual Cert. [23CCR 2630 (d) ] <br /> II Contain( '635 jb) I <br /> Pp. nitted TTRT RenairR r23CCR 2663] <br /> -PP-=JU-sad TTY-irr-rAeias [23CCR '29AQ1 <br /> Cathodic Protection [23CCR 2635 (a) (2) (AIJ <br /> New USTs Monitored Continuously [23CCR 2630] <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Yritv Tp-qt- <br /> Anp31=1 MTV V=nn7-i- [23CC <br /> 2646 (a) <br /> Mgtgrg Calibrated r23QQR 2646 (i) ] <br /> n=i I -Qi- ' k Readi na r21CCR 2646 <br /> E=--itak-LU-21 a InCbe-q r2'ArrR ��64fi (C.) (3 ) LE11_ <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-7aria tAon -P`rocs d-urs--FoI-fowe cL L23CCR 2646 (e) i <br /> T N (SIR) <br /> Inconclusive Procedure Followed [23CCR 2646.1(d) ] <br /> UST Inteqritv Test Every Two Years [23CCR 2646.1( <br /> Annual SIR Report [23CCR 2646.1(j) ] <br /> ]3aiIy SE!ck 'Reacting--1 73CCR-2Z4S---Tc� (1) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ) <br /> AnnuaI ATG Summary Report L2-3CCR-2712 (jD) (2) j <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> AKn--u-WI Tarik-Int—egrItY Tes <br /> an Gauging Procedure k-01l0Wt--U LZ.5ut-�x ,�b4bta) j <br /> ING- <br /> pAily allgtion Pining Monitorjaq [23CCR Ann.II1 <br /> Pi in Tightness Test 123CCR 2643 (b) . (c) , Wl <br /> Gravity Piping Tested Every 2 Years [23CCR 2643 (e) ] <br /> Monthly Line Test23CCR2643Fc-YT2-TT— <br /> MMuaI EeNk Dgtail-lt LZ:TUUX Zb-iUta) j <br /> TANK REMOVAL <br /> Permit to Close orCeaseOper-a-E-0-n-THI&SC 252981 L <br /> Removed, Closed or Tem-p­o-ra`-rI-y Closed [23CCFZ 2670j <br /> REHS INSPECTION DATE/TYPE: <br /> 4 <br /> RECEIVED BY: ;,6 PHONE:LZ/A� 5/w <br /> JP1- 14- Z <br /> Revised Date //1-5—/9-7, 23 CCR UST Regs May 5, 1994 PAGE of <br /> PHS 260 (4/98) <br />