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SAN JOAQUIN COUNTY 0 <br /> OVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, California 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)468-3433 Web:www.siaov.org/ehd <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection <br /> Date: <br /> Facility ad ress: ^vUST# ,, <br /> AI <br /> Produce '- <br /> Facility Contact: / Title: Phone: <br /> Monitoring Panel: Piping system: Overfill prevention: / <br /> TLS 3570 ❑Pressurized uction ❑Gravit echanical ❑AudibleNisual <br /> Inspection type: lations: <br /> outine SWonitoring Certification ❑Installation ❑Other: ❑M1-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=Violation; RV=Re eat Violation V <br /> 1 HSC 25284 Permit to operate <br /> 2 CCR 2637 Secondary containment test performed Q <br /> 3 CCR 2711 b & c Current Unified Program Consolidated Forms on file with EHD (Facility and tank form <br /> 4 ­HSC 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 Ian is onsite. <br /> 7 CCR 2712 b Maintenance&monitoring records M7 <br /> 8 CCR 2643 d Daily monitoring of suction piping (pre-january, 1, 1984 <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632 c 2 UST monitoring system is present imiL <br /> 11 CCR 2630 d UST system monitoring equipment is properl located to detect a leak M7 <br /> 12 HSC 25291 b UST s stem monitoringequipment isoperational M1) <br /> 13 CCR 2636 1 Continuous monitorin system for underground piping&UDC is present M1 <br /> 14 CCR 2631 a Primary containment is product ti ht <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 251 Line leak detectors are installed M1 <br /> 29 <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 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 trainin <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638 a Annual line leak detector test M7 <br /> 26 HSC 25284.2 Annual s ill containment testing <br /> 27 CCR 2636 4 Annual line tightness test M1 <br /> 28 CCR 2661 Repair for tank/piping 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 test for conventional suction piping (pre-janua!y1, 1984 M1 <br /> 31 HSC 25292.5 Double walls stem located within 1000'of public well-ELL) <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 /> N388 <br /> HSC 25299��a) � <br /> Disabling leak detection devices <br /> a 8 2 <br /> HSC 25298Illegal abandonment of UST system <br /> Other: <br /> EHD INSPECTOR: PHONE: UIC <br /> /Li g�29 0 6 Septic system: <br /> `TC7 O ❑Serves X20 people/day <br /> RECEIVED BY: TITLE: 0 Receives other than sanitary waste <br /> Other disposal methods: <br /> ❑Dry wells/French Drains <br /> EHD 23-02-002 REV 8/08 <br />