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SAN JOAQUIN COUNTY DATE/10� <br /> IRONMENTAL HEALTH DEPARTM&T PR# <br /> 30*,--. Weber Ave., Third Floor, Stockton, CA 1-F02 PAGE <br /> (209)468-3420 <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br /> FAutomatic <br /> Name,--' C'1a� Facility Address <br /> Contact Ti#le <br /> Phone # 3Z <br /> Product_9-UL UST#Product <br /> UST#�Prod�uct L� UST# _ <br /> Overfill revention: ❑AudibleNisual D Mechanical Product <br /> stem: D Gravity Pressure L7 Suction Monitoring Panel:. <br /> Pum Shut Down Satisfies CCR 2B3C 5 : D Yes D No Violations: D M1-RDet Q M2-Rprev D M3-Both <br /> ON TYPE: outine ❑Monitoring Certification i2Complaint DlnstallDes 111 at Reovall DRe air/U NAME: P Pgrade <br /> TECHNICIAN NAME: <br /> PHONE- <br /> VIOLATION(S) <br /> The above facility is not in compliance with the following section(s) of Health & Safety Code (HSC) and/or <br /> California Code of Regulations (CCR): <br /> 1 HSC 25284 Permit to operate <br /> 2 CCR 2637Secondary cont. testing 23 CCR 2643 (d) Daily monitoring of suction <br /> 3 CCR 2711(b) & (c) Current State Forms A& B Piping (pre-1/1/84) <br /> 4 HSC 25292.2 24 CCR 2636 (a) Conventional suction piping <br /> Certification of financial p'p' g <br /> responsibility& CFO letter shall have continuous <br /> 5 CCR 2632 (c)(2) UST monitoring is present (M1) monitoring & 21 containment <br /> 6 CCR 2630 (d) UST system monitoring 25 CCR 2643 (e) Biennial tightness test of gravit' <br /> equipment is properly located to 26 CCR 2643 d piping (Pre-1/1/84) <br /> detect a leak (Mi) ( ) Triennial line test for <br /> 7 HSC 25291 (b) UST system monitoring conventional suction (pre- <br /> equipment is operational (MI) 1/1184) (M'!) <br /> 8 CCR 2636 (f){1) Continuous monitoring system 27 'CCR 2661 Permit to repair UST system <br /> 28 HSC 25286 (a) Permit to alter monitoring <br /> for underground piping & UDC <br /> is present(M1) 29 HSC 25298 a system <br /> 9 CCR 2636 {c}{1) All releases in secondary piping ( ) illegal abandonment of UST <br /> 10 HSC 25291 {fHSC 25298 flow to a collection sump 30 system <br /> ) Line leak detector(s) (MT) {b) Permit to temporarily close USI <br /> 11 NSC 25291(a)(2) Secondary containment forsystem <br /> UST is tight 31 HSC 25298 {c) Permit to close UST system <br /> 12 CCR 2635(b)(1) Spill container(M2) 32 HSC 25292.1 UST system is operated to <br /> 13 HSC 25284.2 Annual spill container testingPrevent unauthorized release <br /> 33 <br /> 14 CCR 2635 (b)(2) Overfill prevention system (M2) CCR 2650 Recording/reporting <br /> 15 CCR 2631 (a) Primary containment is product- unauthorized release (M1) <br /> tight 34 HSC 25291 (e) Water in 20 cont analyzed and <br /> 16 ✓ CCR 2632 (c)(2)(D)Monitoring & response planproperly disposed of <br /> i7CCR 2712 (i) Monitoring & response plan is 35 CCR 2640 (e) Single wall component within <br /> on site 1000' of Public Well, no ELD <br /> 18-CCR 2712 (b) Maintenance & monitoring <br /> 36 CCR 2635(x)(2)(A) Cathodic protection testing & <br /> records (M1) 60 day inspection log (M2) <br /> 19 CCR 2636 (f)(4) Annual line tightness test 37 HSC 25299(x)(9) Disabling leak detect. Devices <br /> 20 CCR 2638 (a) Annual line leak detector test 38 CCR 2715(a) Statement from UST owner <br /> (M1) 39 CCR 2715(c) <br /> 40 ( ) Monthly inspection by D.O, <br /> 21 CCR 2638 a CCR 2715 (f) D.O. trained employees <br /> 22 { ) Annual monitoring certification 41 <br /> CCR 2661 (f) Repair for tank/piping has had Violation(s) not listed above <br /> ti fitness test M2 <br /> EHD INSPECTOR: <br /> PHONE <br /> RECEIVED BY: 1 <br /> Septic System: TITLE: <br /> 0 Serves 2t 20 persons/day Q Receives other than sanitary waste <br /> Other Disposal Units Identified. O Dry wells/French Drains <br /> CMOCUME-1 k6acksonTOCALS-1 aemp%UST inspedieng.15.04.DOC <br />