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17 <br />PUBLIC HEALTH SERVICES SAN <br />ENVIRONMENTAL HEALTH <br />304 E. Weber Ave., Third Floor, <br />(209) 468-3420 <br />JOAQUIN COUNTY <br />DIVISION <br />Stockton, CA 95202 <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility Name 4-PAY"71 i I Pr gram ID# <br />Facility Address_ f6kA /51idcity - L -a 4/- zip <br />UST: Dual Wall L.,"Single Wall OVIRrILL, Audible ViLdual Mecbanical -I <br />PIPING SYSTEM: Dual wall-21—ncrle wall Suction Pressure �-Gravity <br />DOES THE LDETECTION SY <br />-NT-EM -meet 23CCR 2636(g) requirements? YES No-�- <br />EAK <br />VIOLATIONS <br />UST GENE Z REQUIREMENTS <br />Permit to Operate [H&SC 2528T4—] <br />-Fo—rms A-& 9 -Curre-n-t--T-H&SC 25284 ) (c) I <br />monitoringZmaintenance Records [23CCR 2712(b)] <br />Einancial ReRnnnAihility rH&Rr 25292-2(a)l <br />Monitoring Records Available [23CCR 2712) <br />Monitorina Plan [23CCR 2632(d)(1)] <br />Resnonse PIgn [23QCR-2632-(d)(2)] <br />Unauthorized Releases Reported [H&SC 25295] <br />Monitoring Equipment Annual Cert. [23CCR 2630(d)] <br />Over s on ainer <br />PArmitted 179T Rppaira r?-ArrR 26611 <br />Re=if-j--ei TT-arades [2'zrrT? <br />Cathodic Protection [23CCR 2635(a)(2)( <br />New USTs Monitored Continuously [23CCR 2630] <br />MANUAL INVENTORY RECONCILIATION (MIR) <br />-U3Z-1=grity Tes <br />Annua3 MIR Repa=t--LZ2 6,4fi 1 <br />ars Calibrated r23CCR 2646(i)] <br />Dailu Stick geadJng [23C -CR ':)9Arf,) 11)1 - <br />ancrina Ati nk in 1 �A InnhpA [23CCg 2fiAg (r) (1) (-F.) 1 <br />Monthly variations Calculated [23CCR 2646(d)] <br />Rx -Variation Procedure FolIowea [23CCR'2'646(e)j <br />UON (STE) <br />Inconclusive Procedure Followed [23CCR 2646.1(d)] <br />UST Integrity Test Every Two Years [23CCR 2646.1LqjL_ <br />Annual SIR Report [23CCR 2646.1(j)] <br />Daily is Reading LZJUL;x 2649 (c) (13 T - <br />Monthly ATG Results [23CCR 2643(b)(1)] <br />Annual ATG -Zu-mma-ry-Re-port <br />MANUAL UST TANK GAUGING (MTG) <br />Tank Gauging Weekly [23CCR 2645(b)] <br />AffnuaI Ta­flR'-'IritegTr-1T—y7est [23CCR 2645UDT-J— <br />TanR OR <br />Daily Qa2tign Pini a Monitoring r23(!CR An]2,,II] <br />Pi in Tightness Test [23CCR 2643(b),(c),(d)T777-- <br />Gravity Piping Tested Every 2 Years [23CCR-2643(e)] <br />Monthly—Line Test [23CCR 2643(c)(2)] <br />mmal EENR V <br />TANK REMOVAL <br />Permit f4 -Close o ease operation[H&SC 252981 <br />Remov jase da-d�em orar ose 2 CTR 2 9 7 0] <br />R E H S JIM <br />" UZ 01 WA <br />FJY.4'1 "7 INSPECTION DATE/TYPE: <br />J, <br />RECE D <br />BY: <br />PHONE: <br />Kq <br />7A- <br />Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br />PHS 260 (4/98) <br />