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PUBLIHEALTH SERVICES SAN JOAQUIPCOUNTY <br />ENVIRONMENTAL HEALTH DIVISION <br />304 E. Weber Ave., Third Floor, Stockton, CA 95202 <br />(209) 468-3420 <br />UST GENERAL REQUIREMEMS <br />Permit to 22erate [H&SC 25284] <br />Forms A& B Current LH&SC 25284(b)jc)j <br />MonitorinqZmaintenance Records [23CCR 2712(b)] <br />Financial Resnonsibility rT4&SC 25222.2(a)l <br />Monitoring Records Available [23CCR 2712) <br />Monitoring Plan [23CCR 2632 d 1)] <br />Be nsa Plan r I= 26a2JAU2) ] <br />Unauthorized Releases Re]2orted [H&SC 25295] <br />Monitoring Equipment Annual Cert. L23CCR 2630(ffTT- <br />Over sll Container L23CCE� <br />Pnni?-.q r?.,arrp 9r, 1] —1 <br />Re=jtt,ed Up-radess r,,>,Arrp 7rrnl - <br />Cathodic Protection [23CCR 2635(a)(2)(Al] <br />New USTs Monitored Continuously [23CCR 2630] <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />_UST J=P-crritv Ti-at­12,3jCfX­� <br />Anpua-] MIR rq-z - D '39ZAr. (er) I <br />paj]jr St-ig-le PmmAineT rqArri? 2646(c) (313 <br />iiaina Stick in 1/8 T33riit-A r2l= 2646 (Q) (:L) <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex-VarJatLori rocedure-FollOwe d L23C-CIZ 2646(e)] <br />-6=12TIQU QRX RZCQNCZJ&1&TZD2LJ=) <br />Inconclusive Procedure Followed [23CCR 2646.1(d)] <br />UST Integrity Test Every Two Years [23CCR 2646.1(q)] <br />Annual SIR Report [23CCR 2646.1(j)] <br />DalIy is Reading [23= 2646 (c)(1)] <br />.L= ic TAM am NO (ATr.) <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />7=uaI ATG summary IZeporE L23CCR 2712(b)(2)j <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />=nual an IrifegFlty Te5f [23CCR 2645 tr)) <br />an aau In roceaure Foi=eZ[ [23CCR 2645 (ZI) I <br />21 <br />12aily auction Piping Monitoring r23CQR ApR,111 <br />Pi in Tightness Test [23CCR 2643(bc),(d)] <br />Gravity Piping Tested Ever X 2 Years [23CCR 2643(e)] <br />Monthly Line Test L23CCR 2643(c)(2)] <br />7MITUaI UeaK DgreZ!tor TeZr-[23CCR 2530(a)] <br />TANK REMOVAL <br />Permit to Close or Cease Operation [H&SC 252981 <br />Removed, Closed or Temporariy Closed [2RCR 2 77F— <br />IL d <br />REHS— -INSPECTION DATE/TYPE: <br />RECEIVED BY: PHONE: P Z", Z <br />Revised Date 7/ 5/97 23 CCR UST Regs May 5, 1994 PAGE of <br />PHS 231 (W) <br />-r-- <br />Facility <br />Name <br />Program <br />ID# <br />Facility <br />Address <br />1 <br />City zip <br />UST: Dual <br />Wall Lo"Single Wall <br />OVERFILL: <br />Audible Visfial Mechanical. <br />PIPING SYSTEM: Dual wall wall <br />Suction Pressure Gravity <br />DOES THE <br />—Single <br />LEAK DETECTION SYSTEM <br />meet 23CCR <br />2636(8) requirements? YES NO <br />VIOLATIONS <br />UST GENERAL REQUIREMEMS <br />Permit to 22erate [H&SC 25284] <br />Forms A& B Current LH&SC 25284(b)jc)j <br />MonitorinqZmaintenance Records [23CCR 2712(b)] <br />Financial Resnonsibility rT4&SC 25222.2(a)l <br />Monitoring Records Available [23CCR 2712) <br />Monitoring Plan [23CCR 2632 d 1)] <br />Be nsa Plan r I= 26a2JAU2) ] <br />Unauthorized Releases Re]2orted [H&SC 25295] <br />Monitoring Equipment Annual Cert. L23CCR 2630(ffTT- <br />Over sll Container L23CCE� <br />Pnni?-.q r?.,arrp 9r, 1] —1 <br />Re=jtt,ed Up-radess r,,>,Arrp 7rrnl - <br />Cathodic Protection [23CCR 2635(a)(2)(Al] <br />New USTs Monitored Continuously [23CCR 2630] <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />_UST J=P-crritv Ti-at­12,3jCfX­� <br />Anpua-] MIR rq-z - D '39ZAr. (er) I <br />paj]jr St-ig-le PmmAineT rqArri? 2646(c) (313 <br />iiaina Stick in 1/8 T33riit-A r2l= 2646 (Q) (:L) <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex-VarJatLori rocedure-FollOwe d L23C-CIZ 2646(e)] <br />-6=12TIQU QRX RZCQNCZJ&1&TZD2LJ=) <br />Inconclusive Procedure Followed [23CCR 2646.1(d)] <br />UST Integrity Test Every Two Years [23CCR 2646.1(q)] <br />Annual SIR Report [23CCR 2646.1(j)] <br />DalIy is Reading [23= 2646 (c)(1)] <br />.L= ic TAM am NO (ATr.) <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />7=uaI ATG summary IZeporE L23CCR 2712(b)(2)j <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />=nual an IrifegFlty Te5f [23CCR 2645 tr)) <br />an aau In roceaure Foi=eZ[ [23CCR 2645 (ZI) I <br />21 <br />12aily auction Piping Monitoring r23CQR ApR,111 <br />Pi in Tightness Test [23CCR 2643(bc),(d)] <br />Gravity Piping Tested Ever X 2 Years [23CCR 2643(e)] <br />Monthly Line Test L23CCR 2643(c)(2)] <br />7MITUaI UeaK DgreZ!tor TeZr-[23CCR 2530(a)] <br />TANK REMOVAL <br />Permit to Close or Cease Operation [H&SC 252981 <br />Removed, Closed or Temporariy Closed [2RCR 2 77F— <br />IL d <br />REHS— -INSPECTION DATE/TYPE: <br />RECEIVED BY: PHONE: P Z", Z <br />Revised Date 7/ 5/97 23 CCR UST Regs May 5, 1994 PAGE of <br />PHS 231 (W) <br />