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0 0 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sicehd.com <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br /> Facility I i FacilInspection/ <br /> eS6(AQQ <br /> Gate:Name: <br /> ddle (W � S �Aa: II� <br /> 1r`1(J <br /> (Contact: c _u�vo Tide: <br /> Inspection USTr• Program: <br /> Type: <br /> Consent Given For. Consent <br /> Tadnspection O'Photos Sampling I Given By: q•(/v� FIeWW <br /> Service TechExp. —�t -I Opegra ted Exp. <br /> Onsite: NI Date: 1 , oMttZ Date: <br /> Service Techniciancfl\) - -I1_ n . � I q <br /> Manufacturer's Training: �I /^ l <br /> CCR=California Code of Regulations HSC=1peafth and Safety Code I CFR=Code of Federal Regulations <br /> V=Violation R=Repeat COS=Corrected on site during impaction <br /> File Review V R COS <br /> 101 HSC 25284 No permit to operate(V650) ❑ ❑ ❑ <br /> 102 HSC 25284(a)(3) No written agreement between tank owner and tank operator to monitor the tank system(V735) ❑ ❑ ❑ <br /> 103 HSC 25292.2 Current financial responsibility documents not submitted(V720) o <br /> 104 CCR 2711 UST Operating Permit Application for Facility and Tank information not submitted or current(V651) ❑ ❑ ❑ <br /> 105 HSC 25286(c) Current BOE number not submitted(V652) ❑ ❑ ❑ <br /> 106 CCR 2632 Monitoring and response plans not current or approved by the EHD(V654) ❑ 1 ❑ 1 ❑ <br /> 107 CCR 2632(d)(1)(C) Plot plaNsite map not submitted or failed to completely show where monitoring is performed(V655) ❑ ❑ ❑ <br /> 108 CCCCRR 2637(o, Failed to notify the EHD 48 hours prior to conducting testing(V671) ❑ ❑ ❑ <br /> 109 CCR 2637 Failed to test secondary containment(V660) ❑ ❑ ❑ <br /> 110 CCR 2637(e) Failed to submit secondary containment test report within 30 days(V662) ❑ ❑ ❑ <br /> 111 CCR 2638(a) Failed to test monitoring and leak detection equipment annually(V659) ❑ ❑ <br /> 112 HSC 25284.2 Failed to test spill containers annually(V661) ❑ ❑ <br /> 113 CCR 2638(d) Failed to submit monitoring system certification test report within 30 days(V823) 0 0 0 <br /> 114 CCR 2636(f) Failed to perform 0.1 gph annual line test for pressurized piping without fail safe or shut down(V663) ❑ ❑ ❑ <br /> 115 CCR 2715(a) Failed to inform the EHD of a charge of designated operator within 30 days(V658) ❑ ❑ ❑ <br /> 116 CCR 2715 Designated operator,service tech or installer did not possess current ICC certification(V717) 0 0 ❑ <br /> 117 HSC 25292.5 Failed to conduct ELD testing on a system located within 1000 of a public well(V672) ❑ ❑ ❑ <br /> 118 HSC 25292.5 Failed to repair and retest system due to failed ELD test(V749) ❑ ❑ ❑ <br /> 119 CCR 2644.1(a)(5) Failed to submit ELD test results within 60 days(V669) ❑ ❑ 0 <br /> 120 CCR 2653 Failed to impact a lined or repaired steel tank within 10 years of lining and every 5 years after(V666) 0 0 ❑ <br /> 121 CCR 2663 Failed to submit tank lining certification within 30 days orto conduct proper tests(V667) ❑ 1 ❑ ❑ <br /> 122 HSC 25299 Documents were falsified or misrepresented(V657) ❑ ❑ ❑ <br /> 123 CCR 2661 Permit to repair UST system not obtained(V673) ❑ ❑ ❑ <br /> 124 CCR 2635(d) Failed to submit UST Certification of Installation/Modification(V840) ❑ ❑ ❑ <br /> 125 CCR 2712(f) Failed to submit a written response within 30 days of receiving an inspection report(\(804) ❑ ❑ ❑ <br /> 126 HSC 25404(e)(4) Failed to report program data electronically(V817) 0 ❑ ❑ <br /> On Site Records V R COS <br /> 201 CCR 2712(b) Failed to maintain alarm logs and/or records of follow up actions(V725) ❑ ❑ ❑ <br /> 202 CCR 2712(b) Failed to maintain cathodic protection test records on site for at least 6 1/2 years(V733) ❑ ❑ 0 <br /> 203 CCR 2712(b) Failed to maintain records of monitoring,repair,lining,and upgrades on site(V732) ❑ ❑ ❑ <br /> Received Inspector. Impecto r r(Q - 2t( <br /> By <br /> Received <br /> Q: Phone: �GIjU 7-I <br /> EHD 23-01 REV 08/07/15 Page 1 UST INSPECTION REPORT <br />