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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 Namee��t" <br />Facility Address Sad�dfa,"JotVcity <br />Zip qy&�— <br />UST: Dual Wall -b-- e Wall OVE ILL: Audible Visual_ Mechanical <br />PIPING SYSTEM: ual wall Single wall Suction Pressure_,K_Gragity <br />DOES THE LEAK DETECTION?Y—STEM meet 23CCR 2636(8) requirements? YES__A NO <br />VIOLATIONS <br />TANK # <br />Permit to Operate [H&SC 252841 11 1 1 II <br />Monitoring Records Available [23CCR 27121 <br />Monitoring Plan [23CCR 2632(d)(1)] <br />Response Plan r23CCR 2632 (r3) (2) 1 <br />Unauthorized Releases Reported [H&SC 252951 <br />New USTs Monitored Continuously [23CCR 2630] <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />Monthly Variations Calculated [23CCR 2646(d)] <br />Ex -variation Procedure Followed L23CCR 264b(e)-1 <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 />Monthly ATG Results [23CCR 2643(b)(1)] 11 1 1 11 <br />MANUAL UST T <br />avity Piping Tested <br />nthiy Line Test 23 <br />TANK REMOVAL <br />Permit to Close or C <br />Removea, Closed or Z <br />REHS <br />RECEIVED BY: <br />Revised Date 7/15/97 <br />PHS 260 (4/98) <br />45 <br />2 Years [23CCR-2643(e <br />43 c 2 <br />eration <br />yl�os <br />SPECTION DATE/TYPE: I_ <br />=7— PHONE: <br />23 CCR UST Regs May 5, 1994 <br />b <br />PAGEof <br />