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-tiiill�it'.�,5".,Caci1!1M;^`Y�.artiM'^.y„�h52RL:ti'��'�'•'x'.....W�,*+�. v1i',�”"„��"r:n .m•.r,- -^., .�-.. ,. , „, «,�- a°w� -^v :vw; r,.: FTy+, i�X _L� t ��:p'- . <br />uL'a r <br />n <br />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 />UNDS7OUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility Name i > Program ID# <br />>�. <br />Facility Address_^ '/`��. City zip <br />UST: Dual Wall / Single Wall OVERFILL: Audible Visual_ Mechanical <br />PIPING SYSTEM: Dual wa11,_,� Single wall Suction Pressure 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 />Forms A & B Current H&SC 25284 c <br />Monitoring/maintenance Records r23CCR 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 />ver sviii Container 123CCR 2635(b)] <br />Permitted UST Repairg 1`21CCR 26911 <br />Cathodic Protection 23CCR 2635 a 2 A <br />New USTs Monitored Continuously [23CCR 26301 <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />HAT Tntearitv TARt [23CCR 2941-11Meters Calibrated r23CCR 2646(1)1 <br />Gauging Stick in 1�8 Inches 1*21= 2r,46(c)(1)(R)l <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -Variation Procedure Foliowed L23CCR 2b4b(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)] <br />Daily Stick Reading c <br />AUTOMATTC! TANK GAUGING (ATG) <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />Annual Afu summary Report <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />Annual an n egri y Test <br />Tanx GaugIng Proceaure Followea <br />Daily Suction Piping monitoring r2 R 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 L23CCR 2643 c 2 <br />Annual e or Test <br />TANK REMOVAL <br />Permit to Flose Cease Operation H&SC 25298 <br />Remove , ose 'or Temporar y Closed 23CCR 2670 <br />RENS INSPECTION DATE/TYPE:JF r <br />RECEIVED BY: , PHONE : '- <br />/_._i.. <br />ti <br />Revised Date 7/15/97``X <br />23 CCR UST Regs May 5, 1994 PAGE of <br />PHS 260 (4198) ` <br />