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0 SAN JOAQUIN COUNTY 00 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.orwehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility n e: Designated Operator: Ins p etion Date: <br /> rot,4 o*/d <br /> Facility address: ��/j UST# , <br /> ' //�/1'l7) VIYw Product / 1 <br /> F cility on[act: Title: ' Phone: <br /> ��fqdn ring P9nel: i 'ng system: Overfill prevention: <br /> 4 >✓NI Pressurized ❑Suction ❑Gravity echamcal ❑Audible/visual <br /> Inspection type: iola[ions: <br /> outine )?)Monitoring Certification ❑Installation ❑Other: 1-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATIONS) HSC=California Health&Safety Code;CCR=Calif rmia Code of Regulations V R <br /> # Code Section V <br /> V=Violation;RV-Repeat Violation <br /> I HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary 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 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 6 Maintenance&monitoring records MI <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 (Ml) <br /> I I CCR 2630 d UST system monitoring equipment is properly located to detect a leak M t <br /> 12 HSC 25291 b) UST system monitoring equipment isoperational (M2) <br /> 13 CCR 2636 I Continuous monitoring system for underground piping&UDC is present Ml <br /> 14 CCR 2631 a Primary containment is product tight <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 25291 Line leak detector(s) are installed Ml <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&20 containment <br /> 21 HSC 25291 (e) Water in 20 containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases Ml <br /> 23 CCR 2715 Designated Operator. a)Statement from UST owner; (c-e)Monthly inspection; t) Employee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638 a) Annual line leak detector test (M 1) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636(1)(4) Annual line tightness test Ml) <br /> 28 CCR 2661 t Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 a Biennial tightness test of gravity piping(pre-January I, 1984 <br /> 30 CCR 2643 d) Triennial line test for conventional suction piping(pre-January 1, 1984) MI) <br /> 31 HSC 25292.5 Double walls stem located within 1000'of public well-ELD <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 /> 36 HSC 25299(a)(9) Disabling leak detection devices <br /> 37 HSC 25298 a) Illegal abandonment of UST system <br /> 38 Other: <br /> EHD 'P O HON / UIC <br /> Septic system: <br /> Serves 10 people/day <br /> RF. IVED BY: TL -Receives other than sanitary waste <br /> Other disposal methods: <br /> VL I (,// -Dry wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />