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�/ SAN JOAQUIN COUNTY y <br /> CNVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, California 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)468-3433 Web:www.sioov.ora/ehd <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection <br /> Date: <br /> oou a <br /> UST# l <br /> Facility add rQ &A-1 <br /> 33 ' ) ( . Product <br /> tpection <br /> tact: Phone: <br /> � M <br /> Panel: i ing system: Overfill prevention: <br /> Pressurized 0 Suction E Gravit E Mechanical Audibletvisual <br /> type: Violations: <br /> Monitoring Certification E Installation E Other: E M1-RDeted M2-RPrev 0 M-3 Both <br /> VIOLATIONS) HSC=California Health &Safety Code; CCR=California Code of Regulations V R <br /> # Code Section V=Violation; RV=Re eat Violation V <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test performed <br /> 3 CCR 2711 b & c Current Unified Program Consolidated Forms on file with EHD(Facility and tank form <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632 b Monitoring Program(Monitoring&Response Plan is current and approved by he local agency. <br /> 6 CCR 2712 i Monitoring Ian is onsite. <br /> 7 CCR 2712 b Maintenance&monitoring records Mt <br /> 8 CCR 2643 d Daily monitoring of suction pipin (pre-January, 1, 1984 <br /> 9 HSC 25292.1 UST s stem is operated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present M1 <br /> 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak M1 <br /> 12 HSC 25291 b UST s stem monitoring equipment isoperational M1 <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping& UDC is present Mt <br /> 14 CCR 2631 a Primary containment is product tight <br /> 15 HSC 25291 (a)(2) Secondary containment for UST is tight <br /> 16 CCR 2636(c)(1) All releases in secondary pipingflow to a collection sum <br /> 17 HSC 25291 Line leak detectors are installed M1 <br /> 18 CCR 2635 (b)(1) Spill container M2 <br /> 19 CC­R2 5 b 2 Overfill prevention system 11112 <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&20 containment <br /> 21 HSC 25291 (e) Water in 20 containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases M1 <br /> 23 CCR 2715 Designated Operator: a Statement from UST owner; (c-e)Monthly inspection; Employee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 1 CCR 2638 a Annual line leak detector test Mt <br /> ?§ q <br /> 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 4 Annual line tightness test Mt <br /> 28CCR 2661 Repair for tank/ in has had tightness test (M2 <br /> 29 CCR 2643 a Biennial tightness test of gravity piping (pre-January 1, 1984 <br /> 30 CCR 2643 d Triennial line lest for conventional suction piping (pre-January 1, 1984) M1 <br /> 31 HSC 25292.5 Double walls stem located within 1000' of public well-ELD <br /> 32 CCR 2661 Permit to repair UST system <br /> 33 HSC 25286 a Permit to alter monitoring system <br /> 34 HSC 25298 b Permit to temporarily close UST system <br /> 35 HSC 25298 c Permit to close UST system <br /> 36 HSC 25299 Disabling leak detection devices <br /> a 9 2 <br /> 37 HSC 25298 a Ille al abandonment of UST system <br /> 38 Other: <br /> �iD INSPE TOR PHONE: UIC <br /> {Ip,fir 9' Septicsve <br /> �✓ [:I Serveses>_22 <br /> 0 people/day <br /> CEIVED TITLE: I.;.Receives other than sandary waste <br /> Other disposal methods: <br /> I!Dry wells/French Drains <br /> EHD 23-02-002 REV 8/08 <br />