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SAN JOAQUIN COUNTY DATE o a <br /> �VIRONMENTAL HEALTH DEPARTN&T PR# <br /> 3 , E. Weber Ave., Third Floor, Stockton, CA 202 PAGE 1 <br /> (209)468-3420 <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> FFacilty <br /> lity Na clAab r1 Facility Add resslym <br /> Contact ft�(� Title A1&,jFf gPhone## ProductUST#IYProduct� UST#.�Product•// UST#_Productill Prevention: ❑AudibleNis�al C'IMechanicalpg System: O Gravity 7pressure O Suction / Monitoring Panel: L <br /> Automatic Pum Shut Down Satisfies CCR 2636 5 : 13 Yes U No Dlesit a ed Operator: <br /> et ❑ M2-Rprev ❑ M3-Both <br /> INSPECTION TYPE: ORoutine OMonitoring Certification OComplaint Olnstall ❑Removal ❑Repair/Upgrade <br /> COMPANY NAME: Rkfe&ZTECHNICIAN NAME 1. <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 23—CCR 2643 (d) <br /> 2—CCR 2637 Secondary cont.testing Daily monitoring of suction <br /> 3 CCR 2711(b) & (c) Current State Forms A& B piping (pre-1/1/84) <br /> 24—CCR 2636 (a) Conventional suction piping <br /> 4—HSC 25292.2 Certification of financial <br /> responsibility&CFO letter shall have continuous <br /> 5—CCR 2832 (c)(2) UST monitoring Is present(MI) <br /> M1) 25CCR2monitoring& 20 containment <br /> 6_CCR 2630 (d) UST system monitoring643 (e) Biennial tightness test of gravitl <br /> equipment is properly located to piping(pre-1/1/84) <br /> detect a leak (M1) 26_CCR 2643 (d) Triennial line test for <br /> 7_HSC 25291 (b) UST system monitoring conventional suction (pre- <br /> equipment is operational (M1) 27—CCR 2661 Perm t)toNrepair UST system <br /> 8—CCR 2636 (f)(1) Continuous monitoring system 28HSC25286 (a) Permit to alter monitoring <br /> for underground piping& UDC system <br /> 9—CCR 2636 (c)(1) All present <br /> (Mn seconds 299—HSC 25298 (a) Illegal abandonment of UST <br /> secondary piping system <br /> flow to a collection sump 30 HSC 25298 (b) Permit to temporarily close USl <br /> 10 HSC 25291 (f) Line leak detector(s)(M1) <br /> 11_HSC25291(a)(2) Secondary containment for system <br /> UST is tight 31—HSC 25298 (c) Permit to close UST system <br /> 12CCR 2635 (b)(1) Spill container(M2) 32—HSC 25292.1 <br /> _ UST systerin is operated to <br /> 13 HSC 25284.2 Annual spill container testing 33—CCR 2650 Recording/reporting <br /> 1unauthorizedprevent release <br /> 4_CCR 2635 (b)(2) Overfill prevention system (M2) <br /> 15 34_HSC <br /> CCR+ 631 (a) Primary containment is product- unauthorized release (zed <br /> tight 25291 (e) Water in 20 cont analyzed and <br /> 16_CCR 2632 (c)(2)(D)Monitoring&response plan properly disposed of <br /> 17—CCR 27+,2 (i) Monitoring & response plan is 35_CCR 2640 (e) Single wall component within <br /> on site 1 000' of Public Well, no ELD <br /> 18 ✓ CCR 2712 (b) Maintenance& monitoring 36 CCR 2635(a)(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(a)(9) Disabling leak detect. Devices <br /> 38_CCR 2715(a) Statement from UST owner <br /> 20 CCR 2638 (a) Annual line leak detector test <br /> (M1) 39—CCR 2715(c) Monthly inspection by D.O, <br /> 21_CCR 2638(a) Annual monitoring certification 40—CCR 2715 (f) D.O. trained employees <br /> 22—CCR 2661 (f) Repair for tank/piping has had Violation(s) not listed above <br /> ti ht ess test M2 <br /> EHD INSPECTOR: PHONE: a <br /> RECEIVED BY: ld I <br /> Septic System: ITLE: <br /> Cl❑Serves 2 2 persons/day ❑Receives other than sanitary waste <br /> Other Disposal Unit Identified: ❑Dry wells/French Drains <br /> C?DOCUME-t4jockson\LOCALS-1\Tenp1UST inspecYmS.15.04.0OC <br />