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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 Name s, . &. Program ID# �c <br /> Facility Address City �ipUST: Dual Wall Single W 11 O RFILL: Audible Visuechanical <br /> PIPING SYSTEM: Dual wallSingle wall Suction Pressure Gravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (g) requirements? YBS_X NO <br /> VIOLATIONS <br /> UST GENERAL R8 UIRM49NTS TANK # <br /> Permit to Operate [H&SC 25284] <br /> Forms A & S Current LH&SC 25284 c <br /> Monitoring/Maintenance Records 23CCR 2712 b <br /> Monitoring Records Available 23CCR 2712 <br /> Monitoring Plan 23CCR 2632 d (1) <br /> Unauthorized Releases Reported [H&SC 25295J <br /> 'rl Monitoring Equipment Annual Cert. E23CCR 2630 <br /> over s511I Container [23CCR 26351b) j <br /> Cathodic Protection 23CCR 2635 a 2 A <br /> New USTs Monitored Continuously [23CCR 26301 <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> Monthly Variations Calculated [23CCR 2646 (d) 3 <br /> Ex-Variation Proceclure Followe e) j <br /> Inconclusive Procedure Followed 123CCR 2646.1 (d.) ] <br /> UST Inte rit 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) ] <br /> Annual ummary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645(b) ] <br /> Annual Tankn egri y es <br /> Tank auging race ure a owe <br /> Monitoring f23CCRA <br /> —Pipincr Tightness Test 23CCR 2643 b c d <br /> Gravity Piping Tested Every 2 Years [23CCR 2643 (e) ] <br /> Monthly Line Test 23CCR 2643 c 2 <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Removed,-closed or Temporar y Closed [23CCR 2670J <br /> REHS ' f INSPECTION DATE/TYPE: <br /> RECEIVED BY: PHONE: <br /> Revised Date 7/15/97 23 CCR UST Regs May 5, 1994 PAGE of <br /> PHS 260 (4/98) <br />