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SAN JOAQUIN COUNTY <br /> NVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 Fmk:(209)468-3433 Web:www.sieov.or <br /> UNDERGROUND STORAGE TANK ST PROGRAM INSPECTION REPORT <br /> Facilitv name: Designated Operator: Inspection Date: <br /> PS D MIS`— �1ti �DrJ X16-, <br /> Facility address: UST# - /L <br /> Facility Contact: Title: Phone: <br /> sV_q, V ( S15 A) C At0lytt N 3- 972 <br /> Monitoring Panel: Piping system: Overfill prevention: <br /> Q ixmsurized ❑Suction ❑Gravityechanical ❑Audible/visual <br /> Inspection type: iolatiom. <br /> Routine YMonitming Certification ❑Installation ❑Other: CMI-RDetect ❑M2-RPmv M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=Califomia Code of Regulations V R <br /> # Code Section V=Violation;RV=Repeat Violation V <br /> 1 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 rc�sponsibility and CFO letter <br /> 5 CCR 2632 b Monitorin Pro (Monitoring&Response Plan is current and approved by the local agency. <br /> 6 1 CCR 2712 i) Monitoring plan is onsite. <br /> 7 1 CCR 2712 b Maintenance&monitoring records 1 <br /> 8 CCR 2643 d Dail monitoringof suction piping(pre-January, 1, 1984) <br /> 9 HSC 25292.1 UST s stem isoperated to revert unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoringsystem is resent (MI) <br /> 11 CCR 2630 d) UST system monitoringequipment is properly located to detect a leak MI <br /> 12 HSC 25291 b UST s stem monitoringequipment isoperation I (M2) <br /> 13 CCR 2636 1 Continuous monitoringsystem for underground piping&UDC is resent Ml <br /> 14 CCR 2631 a) Prim containment is product ti ht <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 (Mi) <br /> 18 CCR 2635(b)(1) Spill container M2) <br /> 19 CCR 2635 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 Recordin reporting of unauthorized releases 1 <br /> 23 CCR 2715 DesignatedOperator: a)Statement from UST owner c- )Ionthl ins ection t) m Io ee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638 a Annual line leak detector test (Ml) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 4 Annual line tightness test Ml <br /> 28 CCR 2661 1) Repair for tank/piping has had tightness test M2) <br /> 29 CCR 2643 a Biennial tightness test of gravity 2ipingre Jan ary I, 1984 <br /> 130 1 CCR 2643 d) Triennial line test for conventional suction piping(pre-Janu 1, 1984) (Ml) <br /> 3lHSC 25292.5 Double walls stem located within 1000'of public well-ELL) <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 temiporatily 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 system <br /> 38 Other: <br /> EHD INSP TOR: PHONE: <br /> 1� (20.?) L149 �( Septic system: X UI �f L� <br /> Nog O O 7 Serves>20 people/day �( <br /> RECEIVED BY: TITLE: �y ! �+/��ta�eceives other than sanita[}}Waste <br /> �,4 y/�K� Other disposal methods: <br /> Lf/1,tYt a- /L( wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />