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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, California 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org <br />UNDERGROUND STORAGE TANK ST PROGRAM INSPECTION REPORT <br />Facilitv name: <br />Designated Operator: <br />Inspection Date: <br />Facility address: UST # - <br />�S/��\ 'Pro net <br />- <br />Facility Contact: Title: Phone: - <br />Mo ittooring Panel: <br />`71-5 3!57b <br />Piping system: Overfill prevention: <br />essurized ❑ Suction ❑ Gravity ❑ Mechanical N�Audible/visual <br />Ins ection type: <br />Routine onitorin <br />Violations: <br />Certification ❑ Installation ❑ Other: ❑ M1-RDetect ❑ M2-RPrev�-3 <br />Both -3 Both <br /># <br />Code Section <br />VIOLATION(S) HSC=California Health & Safety Code; CCR=California Code of Regulations <br />V=Violation; RV=R eat Violation <br />� R <br />V <br />I <br />HSC 25284 <br />Permit tooperate <br />2 <br />CCR 2637 <br />Secondary containment test performed <br />3 <br />CCR 2711 b & c <br />Current Unified Program Consolidated Forms on file with EHD(Facility and tank form <br />4 <br />HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />5 <br />CCR 2632 b <br />Monitoring Program(Monitoring & Response Planis current and approved by the local agency. <br />6 <br />CCR 2712 i) <br />Monitoring plan is onsite. <br />7 <br />CCR 2712 b <br />Maintenance & monitoring records <br />M1 <br />8 <br />CCR 2643 d) <br />Daily monitoring of suction piping (pre -January, 1, 1984) <br />9 <br />HSC 25292.1 <br />UST system isoperated to prevent unauthorized release <br />10 <br />CCR 2632 (c)(2) <br />UST monitoring system is present <br />(M1) <br />11 <br />CCR 2630 d <br />UST system monitoring equipment is properly located to detect a leak <br />M1 <br />12 <br />HSC 25291 <br />UST s stem monitoring equipment isoperational <br />(M2) <br />13 <br />CCR 2636 1 <br />Continuous monitoring system for underground piping & UDC is present <br />M1) <br />14 <br />CCR 2631 a <br />Primary containment is product tight <br />15 <br />HSC 25291 (a)(2) <br />Second containment for UST is tight <br />16 <br />CCR 2636 (c)(1) <br />All releases in secondary pipingflow to a collection sum <br />17 <br />HSC 25291 <br />Line leak detector(s) are installed <br />(MI) <br />18 <br />CCR 2635 (b)(1) <br />Spill container <br />(M2) <br />19 <br />CCR 2635 (b)(2) <br />Overfill prevention system <br />M2 <br />20 <br />CCR 2636 (a) <br />Conventional suction piping shall have continuous monitoring & 2° containment <br />21 <br />HSC 25291 (e) <br />Water in 2° containment analyzed & properly disposed of <br />22 <br />CCR 2650 <br />Recording/reporting of unauthorized releases <br />M1 <br />23 <br />CCR 2715 <br />DesignatedOperator: a) Statement from UST owner; (c -e) Monthly inspection; f) Employee training <br />24 <br />CCR 2638 a <br />Annual monitoring certification <br />25 <br />CCR 2638 a) <br />Annual line leak detector test <br />(M 1) <br />26 <br />HSC 25284.2 <br />Annuals ill containment testing <br />27 <br />CCR 2636 4 <br />Annual line tightness test <br />M1) <br />28 <br />CCR 2661 (f) <br />Repair for tank/piping has had tightness test <br />(M2) <br />29 <br />CCR 2643 e) <br />Biennial tightness test of gravity piping(pre-January 1, 1984 <br />30 <br />CCR 2643 d) <br />Triennial line test for conventional suction piping (pre-January1, 1984) <br />(Ml) <br />31 <br />HSC 25292.5 <br />Double walls stem located within 1000' of public well-ELD <br />32 <br />CCR 2661 <br />Permit to repair UST system <br />33 <br />HSC 25286 a <br />Permit to alter monitoring system <br />34 <br />HSC 25298 b) <br />Permit to temporarily close UST system <br />35 <br />HSC 25298 c <br />Permit to close UST system <br />36 <br />HSC 25299 (a)(9) <br />Disabling leak detection devices <br />37 <br />HSC 25298 a) <br />Illegal abandonment of UST system <br />38 <br />Other: <br />EHD7CTOR. <br />PHONE: <br />) �/ — Zy <br />� F� 7� 1� L� <br />UIC <br />Sytic system: <br />� Serves >_20 people/day <br />^ Receives other than sanitary waste <br />Other dis�sal methods: <br />7 Dry wells/French Drains <br />REC BY: <br />TITLE: <br />EHD 23-02-002 REV 05/07 <br />