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.�,,;:. F'+� .. :4... �;:P t -....� •,��-.ter,-T ..,.��,�� •':y.. ,, r. y. b�N;at. <br /> R s.. <br /> P U B L ALTH SERVICES SAN JOAQU 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 Name [of Program ID# �•_� <br /> Facility Address 4 iii ;A�' City G/t`ir Zi _o <br /> UST: Dual Wall _Single Wall OVERFILL. ?Audible Vis, al hacal <br /> PIPING SYSTEM: Dual wall single wall Suction Pressure G It <br /> DOSS THE LEAK DETECTION S S EM meet 23CCR 2636 (g) requirements? ES NO <br /> VIOLATZONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&SC 252841 <br /> Forms A & B Current rH&SC 25284 c <br /> Monitorin Maintenance Records r23CCR 2712 b <br /> Financial Responsibility rH&SC 2S292-9. (a) l <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 252951 <br /> Monitoring Equipment Annual Cert. 23CCR 2630 <br /> ver splil Container <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 2630] <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Meters ib 2 R 2 4 <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> x- ar a ion Procedure FoiiowecL L23CUR 2b4bte) J <br /> STATISTICAL IRVENTORY 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 /> ai y stick Reading c <br /> AUTOMATIC TANK GAUGING (ATO) <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annual AxU 6ummary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annual Tanxn egri y Iest <br /> Ianx Gaugingroce ure Followea <br /> PIPING MONITORING <br /> Daily u i n 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 <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Remove ,r Closed or Temporar y C ose 23CCR 2670 <br /> REHS INSPECTION DATE/TYPE:.;/ I <br /> RECEIVED BY: PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE-of- <br /> PHS <br /> AGEofPHS 231(9/97) <br />