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DATE <br /> SAN JOAQUIN COUNTY `/ PR# <br /> ENVIRONMENTAL HEALTH DEPARTMENT PAGE <br /> 304 E.Weber Ave.,Third <br /> Floor, Stockton,CA 95202 <br /> (209)468-3420 <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility Name Y- Facility Address ��-I t( 5 <br /> Facilty Contact <br /> �' Title—^«^+ o� 1- Phone <br /> UST# ProductUST#_Product UST#_^P^roduct <br /> UST# Product Monitoring Panel: M K <br /> Overfill Prevention: ❑AudibleNisual ?Mechanical � Violations: >Nlinor ❑Major <br /> Piping System: ❑Gravity ❑Pressure ❑Suction <br /> Automatic Pum Shut Down Satisfies CCR 2636 ❑Yes o Dispenser Pan: as <br /> ❑Yo <br /> INSPECTION TYPE: outine onitoring Certification oComplaint Install Removal Repair/Upgrade <br /> PHONE: <br /> COMPANY NAME: <br /> f TECHNICIAN NAME: <br /> VIOLATION(S) <br /> The above facility is not in compliance with <br /> is he following <br /> olio Regulations in tion/s (CCR)ealth & Safety Code (HSC) and/or <br /> Ca 20 N CCR 2712(b) Maintenance &monitoring <br /> 1 HSC 25284 Permit to operate <br /> records <br /> 2 CCR 2637 Secondary cont testing (6 21 ,/ CCR 2636(f)(4) Annual line tightness test <br /> month/36 month) 22-CCR 2630 (d) Annual line leak detector test <br /> 3 CCR 2711(b)& (c) Current State Forms A& B 23 CCR 2630 (d) Annual monitoring certification <br /> 4ZHSC 25292.2 Certification of financial d) Daily monitoring of suction 24 CCR 2643 ( <br /> responsibility and letter from piping that is not continuously <br /> chief financial officer monitored <br /> 5 CCR 2630 (d) Continuous monitoring system 25 CCR 2643 (d) Triennial tightness test of <br /> for UST system suction piping that is not <br /> 6 CCR 2636 (c)(1) All releases in secondary piping continuously monitored <br /> flow to a collection sump <br /> 7 HSC 25291 (e) Water in secondary(2°)cont 26 CCR 2643(e) Biennial tightness test of gravity <br /> piping that is not continuously <br /> 8 HSC 25291 (f) Automatic line leak detector(s) monitored <br /> 9 CCR 2636 (f)(1) Continuous monitoring system Upgrade requirements for UST <br /> for underground piping system CCR 2662 <br /> 10�CCR 2632(c)(2) Continuous monitoring system <br /> for UST 28 CCR 2661 Permit to repair UST system <br /> 11 HSC 25291(a)(2) Secondary containment for 29 HSC 25286(a) Permit to alter monitoring <br /> UST is tight system <br /> 12 CCR 2636 (f)(1) Continuous monitoring system 30 HSC 25298 (a) Illegal abandonment of UST <br /> for dispenser system system <br /> 13 CCR 2635(b)(1) Spill container 31 HSC 25298(b) Permit to temporarily close UST <br /> 14 CCR 2635(b)(2) Overfill prevention system system <br /> 15 CCR 2631 (a) Primary containment is product- 32 HSC 25298(c) Permit to close UST system <br /> tight 33 HSC 25291 (e) Water in 20 cont analyzed and <br /> 16 HSC 25292.1 UST system is operated to properly disposed of <br /> prevent unauthorized release 34 CCR 2640(e) Single wall component within <br /> 17 CCR 2650 Recording/reporting 1000'of Public Well, no ELD <br /> unauthorized release 35 CCR 2635(a)(2)(A)Cathodic protection testing <br /> 18_CCR 2632 (d) Monitoring &response plan 36 H&SC 25299(a)(9)Disabling leak detect, devices <br /> 19 CCR 2712 (i) Monitoring &response plan is 37 Violation(s)not listed above <br /> on site <br /> EHD INSPECTOR: PHONE: <br /> RECEIVED BY: LE: PHONE: <br /> \ UNmIWSTANSP(rev 3x502) <br />