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V PUBLICHH SERVICES SAN JOA UlI14 C <br /> OUNTY <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E. Weber Ave. , Third Floor, Stockton, CA 95202 <br /> (209) 468-3420 <br /> UNDE GROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br /> Facility Name Program ID# <br /> Facility Address V d City Zip <br /> UST: Dual Wall Single Wall OVERFILL: Audible Vis al echanical <br /> PIPING SYSTEM: Dual wall Single wall Suction Pressure G avity <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (8) requirements. ES NO <br /> VIOLA PONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&SC 25284] <br /> Forms A & B Current THKsc 25284 c <br /> Monitoring/Maintenance Records 23CCR 2712 (b) ] <br /> Financial Responsibility fHkSC 2q292 _2 (a) 1 <br /> monitoring Records Available 23CCR 27121 J <br /> Monitoring Plan [23CCR 2632 (d) (1) ] <br /> Response Plan r23CCR 2632 (d) (2) 1 I <br /> Unauthorized Releases Reported [H&SC 252951 <br /> Monitoring Equipment Annual Cert. L23CCR 2630 <br /> ver spill on ainer <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 26301 <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> meters i ated r23CCR 4 <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> x- aria ion Procedure koiiowed L23CCR 2646 (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 /> AUTOMATIC TANK GAUGING (ATG) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annual ATG Summary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annual ranxn egri y Iest <br /> zanic Gauging roce ure FoIlowecl <br /> ING MONITORING <br /> Daily u i n Pipincr Monitoring r2 CR ADD.III <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 <br /> TANK REMO AL <br /> Permit t Close or Cease Operation H&SC 25298 <br /> Remov C os or Temporar y Closed 23CCR 2670 <br /> REHS INSPECTION DATE/TY <br /> c <br /> RECEIVED BY: PHONE: <br /> Revised Date 7/15/97 23 CCR UST �gay 5, 1994 PAGE of <br /> PHS 231(9/97) C <br />