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DATE ' haLU <br /> ' . SAN JOAQUIN COUNTY PR# <br /> ENVIRONMENTAL HEALTH DEPART ENT PAGE iI <br /> 304 E.Weber Ave.,Third Floor, Stockton, CA 95202 <br /> (209)468-3420 <br /> UNDERGROUND STORAGE TANK(UST} PROGRAM INSPECTION REPORT <br /> Facility Name kms. _Facility Address Q <br /> Facilty Contact <br /> r a w � Title �-- Phone # 'f c(c(-)Z <br /> UST# '� Product UST# Product UST# Product UST# Product <br /> Monitoring Panel:_'rt5 3 <br /> Overfill Prevention: ❑AudibleNisual Mechanical Violations: Malar <br /> Piping System: ❑ Gravity Pressure c3Suction <br /> Automatic PUm13 Shut Down Slatisfies CCR 2636 : C1Yes E16 Dispenser,,Pan: Yes ❑ No <br /> INSPECTION TYPE: '�7Routine onitoring Certification ❑Ca faint ❑Install ❑Removal ❑RepairlUpgrade <br /> COMPANY NAME: r�u- <br /> TECHNICIAN NAME: V%-- 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 20 CCR 2712 (b) Maintenance & monitoring <br /> records <br /> 2 CCR 2637 Secondary cont testing (6 <br /> 21 '✓CCR 2636 (f)(4) Annual line tightness test <br /> month/36 month) <br /> (d) Annual line leak detector test <br /> 3 CCR 2711(b) & (c) Current State Forms A& B 22 CCR 2630 <br /> 4 HSC 25292.2 Certification of financial 23 CCR 2630 (d) Annual monitoring certification <br /> responsibility and letter from 24 CCR 2643 (d) Daily monitoring of suction <br /> piping that is not continuously <br /> chief financial officer <br /> monitored <br /> 5 CCR 2630 (d) Continuous monitoring system <br /> far UST system 25 CCR 2643 (d) Triennial tightness test at <br /> 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 /> secondary(2°) cont 26 CCR 2643 (e) Biennial tightness test of gravi <br /> Water in secon <br /> 7 HSC 25291 (e) 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 7 CCR 2662 Upgrade requirements for US <br /> for underground piping 2 <br /> system <br /> 10 CCR 2632 (c)(2) Continuous monitoring system <br /> for UST 28 CCR 2661 Permit to repair UST system <br /> or US a containment for 29 HSC 25286 (a) Permit to alter monitoring <br /> 11 HSC 25291(a)(2) Secondary .system <br /> UST is tight 30 HSC 25298 (a) Illegal abandonment of UST <br /> ,/� <br /> 12 \ CCR 2636 (f)(1) Continuous monitoring system system <br /> for dispenser system 31 HSC 25298 (b) Permit to temporarily close U: <br /> 13 CCR 2635 (b)(1) Spill container system <br /> 14 CCR 2635 (b)(2) Overfill prevention system 32 HSC 25298 (c) Permit to close UST system <br /> 15 CCR 2631 (a) Primary containment is product- 33 HSC 25291 (e) Water in 20 cont analyzed an( <br /> tight properly disposed of <br /> 16 HSC 25292.1 UST system is operated to 34 CCR 2640 11 Single wall component within <br /> prevent unauthorized release 1000' of Public Well, no EL'D <br /> 17 CCR 2650 Recording/reporting <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 /> 1`a CCR 2712 (i) Monitoring & response plan is <br /> 37 Violation(s) not listed above <br /> on site <br /> PHONE: y J 7 <br /> EHD INSPECTOR: <br /> TITLE: PHONE: <br /> RECEIVED BY: <br /> UNITIIVUSTIINSP(rev 315102) <br />