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0 SAN JOAQUIN COUNTY 40 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, California 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)468-3433 Web:www.siooy.org/ehd/unitiii.htmi <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br /> Facility name: Inspection date: <br /> -�- vim bb as 10 <br /> Fajil'ity address: �� - - UST#I r I , S;1 1 b/ I <br /> Product <br /> Facility contact: Title: Phone: <br /> V cP'�' G�3 <br /> Monitoring panel: Piping system: Overfill prevention: Violations: <br /> �M 'ressurized 0 Suction C Gravity echanical ;R -RDetect 0 M2-RPrev D M-3 Both <br /> D Audible/visual <br /> Inspection type: Sas-! nated operator, NS ate: <br /> outine Monitoring Certification D Installation 0 Other: `� "' T <br /> On site Service Technician's name: x .date: Manufacturer's train' g: <br /> �Ur U12- Lev a UV0� vgds�i <br /> 'I LTJ LATIONS R <br /> # Code Section VIOV <br /> HSC=CA Health&SafetyCode; CCR=CA Code of Regulations;V=Violation; RV=Re eat Violation V <br /> 1 HSC 25284 No permit too erate <br /> Secondary containment: (a)test not performed; (e)test report not submitted within 30 days; (f)test <br /> 2 CCR 2637 notif cation not provided to the Environmental Health Department(EHD)at least 48 hours prior to <br /> conducting the test 2-50O <br /> 3 CCR 2711 b & c • Current Unified Program Consolidated Forms not on file with the EHD (Facility and tank form <br /> 4 HSC 25292.2 Current financial responsibility documents not on file with the EHD Ochillo <br /> 5 CCR 2632(b) Monitoring Program(Monitoring&Response Plans is not current or approved by the EHD <br /> 6 CCR 2712 i Monitoring and/or response plan is not onsite <br /> Maintenance&monitoring records not maintained 3 years, cathodic protection records for 6 Y2 (Mi) <br /> years,written performance claims pertaining to release detection systems for 5 years,or records of <br /> repairs, linings,and upgrades for the life of the tank. Monitoring records include: (1)date and time of <br /> 7 CCR 2712(b) all monitoring or sampling; (2) monitoring equipment calibration and maintenance records; (3) results <br /> of any visual observations;(4)results of sample analysis performed a lab or in the field; (5) logs of all <br /> readings of gauges or other monitoring equipment,ground water elevations,or other test results; (6) <br /> results of inventory readings and reconciliations <br /> 8 CCR 2643(d) Daily monitoring of suction piping (pre-January1, 1984 not performed (Mil <br /> 9 HSC 25292.1 UST system is not operated to prevent unauthorized release, including spills and overfills <br /> 10 CCR 2632(c)(2) Monitoring system is not present in the interstitials ace of a double walled UST/piping (M1) <br /> 11 CCR 2630(d) UST monitoring equipment is not installed or maintained to detect a leak at the earliest opportunity(mi) <br /> 12 HSC 25291(b) UST monitoring system incapable of detecting leak from primary containment into secondary (M1) <br /> containment <br /> 13 CCR 2636(f)(1) Failed to maintain a continuous monitoring system for underground piping& UDCs that activates (M1) <br /> an audible and visual alann or stops flow of product at the dispenser when it detects a leak <br /> 14 CCR 2631 a Primary containment is not product tight <br /> 15 HSC 25291(a)(2) Secondary containment for UST system is not tight <br /> 16 CCR 2636(c)(1) All releases in secondary pipingdo not flow to a collection sum <br /> 17 CCR 2636(f)(2) Line leak detectors not installed or failed to detect a 3-gallon per hour leak at 10 psi M1) <br /> 18 CCR 2635(b)(1) Spill container not installed,failed to contain a minimum capacity of five gallons,or failed to (M2) <br /> provide a means to keep the spill container empty <br /> 19 1 CCR 2635(b)(2) Overfill prevention system was overridden or failed to meet overfill requirements in this section (M2) <br /> 20 CCR 2636(a) Failed to have secondary containment for piping(includes conventional suction piping) (M2) <br /> 21 HSC 25291(e) Water in 20 containment not removed, analyzed& properly disposed of <br /> Unauthorized release that:(c)did not escape secondary containment and cleaned up within eight (M1) <br /> 22 CCR 2650 hours was not recorded; (e)escaped secondary containment, not cleaned up after eight hours, or a <br /> sudden loss of product was not reported to the EHD within 24 hours <br /> 23a CCR 2715(a) Failed to inform the EHD of a change of designated operator within 30 days <br /> 23b CCR 2715(b) Designated operator did not possess a current ICC UST System Operator certification <br /> EHD inspector: Received by: Title: <br /> EHD 23-02-002 R V 04/08/10 Page 1 UST OFFICIAL INSPECTION REPORT <br />