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PUBLIC HEALTH SERVICES SAN <br />ENVIRONMENTAL HEALTH <br />304 E. Weber Ave., Third Floor, <br />(209) 468-3420 <br />E <br />JOAQUIN COUNTY <br />DIVISION <br />Stockton, CA 95202 <br />UNDE OUND STTQRAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility Name Program ID# <br />Facility Address Mt) city Zi <br />UST: Dual Wall,.-' -Single w 11 OVERFILL: Audible Visual Mechanical <br />PIPING SYSTEM: Dual wall'!�� Single wall SuctionPressureGravity Z <br />DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636(8) requirements? YES NO <br />VIOLATIONS I <br />UST GENERAL REQUIREMENTS <br />Permit to Operate [H&SC 25284] <br />_Forms A-& B Current H&SC _2­5_284=cli_� <br />Monitoring/Maintenance Records [23CCR 2712(b)l <br />Financial RasnnnRibility rT4&SC 29292-2-(;4)1 <br />monitoring Records Available [23CCR 2712) -T— <br />Monitoring Plan [23CCR 2632(d)(1)] e� <br />eg]2gligge 21an r2_*1CX!R 2632 (d) (2)1 <br />Unauthorized Releases Reported [H&SC 25295] <br />Monitoring Equipment Annual Cert. [23CCR 2630 <br />ai Container L23CCR 26-15 (b) I <br />Parmi tttwi TTRT PP <br />,.,LUj__d=ajr8 [23CCR 26611 <br />TIp"rades 121rrP 'Dge�nl <br />Cathodic Protection r23CCR 2635(a)(2)(A)l <br />New USTs Monitored Continuously [23CCR 2630] <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />-A= <br />Daillf: Stick Reading r2"Arr"? o,646(c) (j)1 <br />auging Stick in I�R Inch, -.q [23CCE 2646(c)(1)(R)l <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -V - aria tion Proce ure o owe El [2SCCR 2646(e)] <br />18 Ir,"'Ok ON (SIR) <br />I'LL <br />Inconclusive Procedure Followed [23CCR 2646.1(d)] <br />UST Int® aEjLZ_Test Every Two Years [23CCR 2646.1Lqlj_ <br />Annual SIR Report [23CCR 2646.1(j)] <br />DaiIy is Readinij L23CCR--7646 (c)(1)j <br />T a (ATO) <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />==uaI ATG summary Report [23CCR_-2717_(b) (2)1 <br />MANUAL UST TANKIGAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />IMUNI" Tanx Integ-ricy Test <br />an Gauging Procea`ffr-e--F5owe <br />d-[23= Z645ka)j <br />RTNrZ <br />_Djaily allgtion Pin-ing Monitoring r23CCIZ =.III <br />Pi in Tightness Test [23CCR 2643(b),(c),(d)l <br />Gravity Piping Tested Every 2 Years [23CCR 2643(e)] <br />Monthly Line Test [23CCR 2641(c_YT_2_YT_ <br />MMUaI LeAR Defector Tes-E---T73CuRr--2-b-�j <br />TANK REMOVAL - <br />Fermat to ose 2± Ic- ease Operation rH&S­C­_2_52_98T <br />orarly Clo_s_eUT2�CZ!R 2U-7-07- <br />11 If ZIA A .11, 1.11WA <br />RENS N INSPE TION DATE/TYPE:_///,-27-7 <br />— <br />RECEIVED BY: PHONEI ® a � �—� �4Z,) ^(11 /7 <br />Revised Date 7/15/97(�r 23 CCR UST Regs May 5, 1994 PAGE of <br />PHS 260 (08) <br />