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SAN JOAQUIN COUNTY <br /> -WNVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 9520P708 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web: www.s' oy.or fehd <br /> Facility name: UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Designated Operator: Inspection Date: <br /> Facility address: �J <br /> UST# r <br /> - Product Qcm <br /> Facility Contact: Title: c�Phone: -y� <br /> Monitoring Panel: -CVS 3T5Aressuriszed <br /> PPip�sytem: 42chanicap] <br /> fill prev <br /> QM ❑Suction Q Gravityblelvisual <br /> Ins ection type: � tions: <br /> outinc l�1dGlonitoring Certification ❑Installation C]Other: I-RDetect ❑M2-RPrev Q M-3 Both <br /> # Code Section VIOLATIONS) HSC=California Health&Safety Code;CCR=California Code of Regulations V R <br /> V=Violation;RV=Re eat Violation V <br /> 1 HSC 252$4 Permit tooperate <br /> 2 CCR 2637 Second containment test performed <br /> 3 CCR 2711 {b)& c) Current Unified Pro ram Consolidated Forms on file with EHD(F cility and tank form <br /> 4 HSC 25292.2 Certification of financial res onsibilit and CFO letter <br /> 5 CCR 2632 c {2 (D Monitorin &res onse Ian is current and filed with the local agency <br /> 6 CCR 2712{i) Monitorin &response plan is onsite <br /> 7 CCR 2712(b) Maintenance&monitoring records <br /> 8 CCR 2643(d) Dail monitoringof suction piping(Pte-January, 1, 1984) M1 <br /> 9 HSC 25292.1 UST s stem iso erated to n-event unauthorized release <br /> 10 CCR 2632 c 2 UST monitorings stem is resent <br /> 11 CCR 2630 d) UST s stem monitorin a ui mentis ro er[y located to detect a leak (MI) <br /> 12 HSC 25291 b UST s stem monitorin a ui ment iso erational MI <br /> 13 CCR 2636 f){1) Continuous monitorin s stem for under round 2iping&UDC is 2resent (M2) <br /> 14 CCR 2631 a Primary containment is roduct ti ht MI) <br /> 15 HSC 25291 a)(2) Second—containment for UST is ti ht <br /> 16 CCR 2636(c (1 A1l releases in secondary pieiinflow to a collection sum <br /> 17 HSC 25291 (f) Line leak detector(s)are installed <br /> 18 CCR 2635 (b (1) Soil]container (MI) <br /> 19 CCR 2635 (b)(2) Overfillrevention system (M2 <br /> 20 CCR 2636 (M2 <br /> a <br /> ( ) ConyentionaI suction piping shall have continuous monitorin &2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&properly disposed of <br /> 22 CCR 2650 Recordin re ortin of unauthorized releases <br /> 23 CCR 2715 Desi nated O erator: (a)Statement from UST owner; (ae)Monthly inspection;(f)Employee trainin MI <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638(a Annual fine leak detector test <br /> 26 HSC 25284.2 Annuals ill containment testing (MI) <br /> 27 CCR 2636 4) Annual line ti htness test <br /> 28 CCR 2661M1 <br /> (� Re air for tank/ i htness test i in has had t (M2 <br /> 29 CCR 2643 (e Biennial ti htness test ofgravity i in re-Januar 1, 1)84 <br /> 30 CCR 2643 (d) 'Triennial line test for conventional suction piping( re-Jana 1, 1984 <br /> 31 HSC 25292.5 Double wall system located within 1000'of ublic well-ELD (M1 <br /> 32 CCR 2661 Permit to re air UST system <br /> 33 HSC 252$6(a Permit to alter monitoring system <br /> 34 HSC 25298{b Permit to te--p-prity close UST system <br /> 35 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: <br /> D INSP PHONE: <br /> GIC <br /> 5e tics y stem; <br /> ECE EJ Serves>_20 people/day <br /> TITLE- -Receives other than sanitary waste <br /> i Other disposal methods':/QRJA <br /> Dry wells/French Drains <br /> EHD 23-02-002 <br />