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SAN JOAQUIN COUNTY <br /> OVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.or <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date. <br /> LA� ,r1 .1-f- 1112.616--) <br /> Facility address: UST# <br /> '1eeaC4 1!G Product <br /> Facility Contact: Title: Phone: <br /> Moni ing Panel: <br /> + Piping system: Overfill prevention: <br /> -357,5;1 ❑Pressurized ! uction ❑Gravity ❑Mechanical Audible/visual <br /> Ins ection type: Violations: <br /> ❑Routine X-11nitoring Certification i-1 histallatim ❑Other: ❑MI-RDetect 2-RPrev C M-3 Both <br /> # Code Section <br /> VIOLATION(S) HSC=Califomia Health&Safety Code;CCR=California Code of Regulations v R <br /> V <br /> V=Violation;RV=Re eat Violation <br /> I HSC 25284 Permit to operate <br /> 2 CCR 2637 Secondary containment test pertonned <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 the local agency, <br /> 6 CCR 2712 i) Monitoring plan is onsite. <br /> 7 CCR.2712 b Maintenance&monitoring records (M1) <br /> 8 CCR 2643(d) Daily monitorin of suction piping(pre-January, 1, 1984) . <br /> 9 HSC 25292.1 UST system is operated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitorin system is present (M1) <br /> 1 l CCR 2630 d) UST system monand.rigrequipm, t is properly located to etect a leak (M 1) <br /> 12 HSC 25291 b) UST system monitoring equipment is operational (M2) <br /> 13 CCR 2636 f)(1) Continuous monitoring system for underground piping&UDC is present (M 1) <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 piping flow to a collection sum <br /> 17 HSC 25291 f) Line leak detector(s)are installed (M1) <br /> 18 CCR 2635(b)(1) Spill container (M2) <br /> 19 CCR 2635 b)(2) Overfill prevention system (M2) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&properly disposed of <br /> 22 CCR 2650 Recordin Ire ortin of unauthorized releases M1) <br /> 23 CCR 2715 Desi nated Operator: (a)Statement from UST owner, (c-e)Monthly ins ection;(f)Employee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638 a) Annual line leak detector test (MI) <br /> 26 HSC 25284.2 Annual spill containment testing <br /> 27 CCR 2636(f)(4) Annual line tightness test (M1) <br /> 28 CCR 2661 (f) Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 e Biennial tightness test of gravity pipingre-Janus 1, 1984 <br /> 30 CCR 2643(d) Triennial line test for conventional suction piping(pre-January I, 1984) (Ml) <br /> 31 HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to Mair 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 2529$ e) Permit to close UST system <br /> 36 HSC 25299(a)(9) Disabling leak detection devices <br /> 37 HSC 2529$ a) Illegal abandonment of UST system <br /> 38 Other: <br /> EHD INS OR• PHONE: / UIC <br /> �7 ; Ori $--"]GCI Septic system: <br /> Gal / vI O ;.Serves 220 people/day <br /> RECEIV D / TITLE: F Receives other than sanitary waste <br /> Other dispasal methods: <br /> Dry wells/French Drains <br /> EHD 23-02-002 REV 05107 <br />