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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3d Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web.-www.siizov.org] <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> Vld.\QA QDsCNF\C. !\\\t£ �\\k <br /> Facility address: UST k ^d <br /> 3 S• � �� Product 6 <br /> Facility Contact: Title: Phone: <br /> \'\mac V_v,ksu�l�ngm: <br /> OVA%-CNAXI <br /> Monitoring Panel Ov dl prevention: <br /> N4 WQ. ❑Suction ❑Gravity Mechanical ❑Audible/visual <br /> Inspection type: Vi ations: <br /> 01'Routine 11 Monitoring Certification ❑Installation ❑Other: Ml-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATIONS)HSC=Califumia Health&Safety Code;CCR=Califomia Code of Regulations V R <br /> p Code Section V=Violation;RV=Re eat Violation V <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Second containment test performed <br /> 3 CCR 2711 b & c Current Unified Program Consolidated Forms on file with EHD(Facilityand 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 /> 6 CCR 2712(i) Monitoring&response plan is onsite <br /> 7 CCR 2712 6 Maintenance&monitoringrecords 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 MI <br /> I 1 CCR 2630 d UST system monitorinE equipment is properly located to detect a leak MI <br /> 12 HSC 25291 UST s tem monitoring a ui mentisoperational MZ <br /> 13 CCR 2636 1 Continuous monitoring system for underground 2iping&UDC is present MI <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 ] All releases in secondary pipingflow to a collection sump <br /> 17 HSC 25291 Line leak detectors are installed MI <br /> 18 CCR 2635 b 1 ) Spill container (M2 <br /> 19 CCR 2635 2 Overfill Prevention system <br /> M2 <br /> 20 CCR 2636(a) Conventional suction lyipinE 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 Recording/reportingof unauthorized releases Ml <br /> 23 CCR 2715 -Designated Operator: a Statement from UST owner; (c-e)Monthly inspection; Employee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 26"'a) <br /> Annual line leak detector test MI <br /> 26 HSC 25284.2 Annual s ill containment tes[in <br /> 27 CCR 2636 4 Annual line tightness test MI <br /> 28. CCR 2661 Repair for tank/piping has had ti mess test (M2 <br /> 29 CCR 2643 a Biennial tightness test of gravity pipingre-Janua 1, 1984 <br /> 30 CCR 2643 d Triennial line test for conventional suction piping(pre-Janaary 1, 1984) (Mi) <br /> 31 HSC 25292.5 Double walls stem located within 1000'ofpublic well-ELD <br /> 32 CCR 2661 Permit tore air UST system <br /> 33 HSC 25286 a Permit to alter monitoring system <br /> 34 HSC 25298 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 Ille al abandonment of UST s stem <br /> 38 Other: <br /> D INS PHONE: UIC <br /> _ Sentic stem: <br /> L Serves>_20 people/day <br /> EIVED BY: TITLE: Receives other than sanitary waste <br /> _PC <br /> ( Other disposal methods: <br /> L ^'Jl0 C 1 yl ej - wells/French Drains <br /> EHD 23-02-002 <br />