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' SAN JOAQUIN COUNTY <br /> t ONVIRONMENTAL HEALTH DEPARTMENT 40 <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202= 708 <br /> tr Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sij4ov.org/ch <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> 6apa'r, lel we VAL&(Lo STN(iRlJ S 3-�-Oto <br /> Facility address: UST# C , <br /> �.L}-10 w. &M r` k-ANE: R o Product <br /> Facility Contact: Title: Phone: <br /> i4p„J M(N4" A(ztN(:�Q' - S 32-It <br /> Monirt�orrr�n}¢-fP,anel: , ^,,' `yP'ping system: O•erfrll prevention: <br /> W�•"�+ G"�`-' /UPressurized ❑Suction ❑Gravity Mechanical ❑Audible/visual <br /> Inspection type: �� Violations: <br /> ❑Routine L2 Monitoring Certification El Installation Other: ❑MI-RDetect ❑M2-RPrev ❑M-3 Both <br /> # Code Section <br /> VIOLATIONS) HSC=Califomia Health&Safety Code;CCR=Califomia Code of Regulations V R V=Violation;RV=Re eat Violation V <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test performed <br /> 3 CCR 2711 6 &(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(c)(2)(D) Monitoring&response plan is current and filed with the local agency <br /> _ <br /> 6 CCR 2712(i) Monitoring&response p Tan is onsite <br /> 7 CCR 2712(b) Maintenance&monitoring records (Ml) <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 /> 11 CCR 2630(d) UST system monitoring equipment is properly located to detect a leak Ml <br /> 12 HSC 25291 (b) UST system monitoring equipment p isoperational M2 <br /> 13 CCR 2636(n(l) Continuous monitoring system for underground piping&UDC is present Ml <br /> 14 CCR 2631 (a) Priminry 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 secondpipingpflow to a collection sum <br /> 17 HSC 25291 (t) Line leak detectors are installed Ml <br /> 18 CCR 2635(b)(1) Spill container (M2) <br /> 19 CCR 2635(b)(2) Overfill prevention system M2 <br /> 120 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 Recordingtreporting of unauthorized releases Ml <br /> 23 CCR 2715 Desi nated 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(n(4) Annual line tightness test Ml <br /> 28 CCR 2661 (f) Repair for tank/piping has had tightness test M2 <br /> 29 CCR 2643(e) Biennial tightness test ofgravity piping re-Janus 1, 1984 <br /> 30 CCR 2643 d Triennial line test for conventional suction ppipingg(pre-January 1, 1984 (MI) <br /> 31 HSC 25292.5 Double walls stem located within 1000'ofpublic 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) Disablin leak detection devices <br /> 37 HSC 25298 a) Ille al abandonment of UST s stem <br /> 38 Other: C,o+++PUPAjCk- <br /> EHD INSPECTOR: PHONE: UIC <br /> LLQ. qb g-_-51% 0b Septic system: <br /> _N(Al. l ❑Serves>_20 people/day <br /> RECEIVED BY: TITLE: ❑Receives other than sanitary waste <br /> t Other disposal methods: <br /> ❑Dry wells/French Drains <br /> FHD 23-02-002 <br />