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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.(249)468-3433 Web:www.sjgov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> Ucj <br /> Facility address: US['# , <br /> i <br /> + CiC' t/::— Product f> e <br /> Facility Contact: Title: Phone: <br /> Monitorin Panel: Piping system: Overfill prevention. <br /> (r —3�C7 ❑Pressurized action ❑Gravi ❑Mechanical udible/vistial <br /> Inspection type: Violations: <br /> outine ❑Monitoring Certification ❑Installation ❑Other: 1-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC-California Health&Safety Code;CCR=California Code of Regulations V R <br /> # Code Section V <br /> V=Violation;RV=R eat Violation <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Second2a 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 Certifieation of financial responsibility and CFO letter <br /> 5 CCR 2632 b Monitoring Program(Monitoring&Response Plan)is current and approved bx the local agency. <br /> 6 CCR 2712 i Monitoring tan is onsite. <br /> 7 CCR 2712(b) Maintenance&monitoring records (M l) <br /> 8 CCR 2643 d) Daily monitoring 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 monitoring system is present (MI) <br /> I 1 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 (M2) <br /> 13 CCR 2636(t)(1) Continuous monitoring system for underground Piping&UDC is present (M1) <br /> 14 CCR 2631 a) Primary containment is Rroduct tight <br /> 15 HSC 25291 a) 2) Secondary containment for UST is tight <br /> 16 CCR 2636(c)(1) All releases in secondary pipinaflow to a collection sum <br /> 17 HSC 25291 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&LmlortinE of unauthorized releases (M 1) <br /> 23 CCR 2715 DesignatedOperator:(a)Statement from UST owner; (c-e)Monthly inspection;(f)Employee training_ <br /> 24 1 CCR 2638 a) Annual monitoring certification X <br /> 25 CCR 2638(a) Annual line leak detector test (Y11) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636(f)(4) Annual line tightness test (M 1) <br /> 28 CCR 2661 (f) Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 e) Biennial tightness test of gravity Ripingre-Janus 1, 1984 <br /> 3W CCR 2643(d) Triennial line test 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 r air 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 1 HSC 25298(c) Permit to close UST system <br /> 36 HSC 25299(a)(9)__ Disabling leak detection devices <br /> 37 HSC 25298 a) Illegal abandonment of UST system <br /> 38 Other: LL <br /> FAD INSPE PHONE: UIC <br /> Septic system: <br /> ra <br /> L Serves 220 peoptelday <br /> RECEIVED TITLE: r-Receives other than sanitary waste <br /> r" Other disposal methods: <br /> Dry welWFrench Drains <br /> EHD 23-02-002 REV 05107 <br />