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1 <br /> Salt'JoA4U1N COUNTY <br /> ENVIRONMENTAL,HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:W W.s' ov.or ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT Inspection Date: <br /> Designated Operator: <br /> Facility name: <br /> UST# 1 �/ <br /> Facility address: / I/ <br /> �sr ,� - / Prvduet <br /> `^ Title: ! Phone: <br /> Facility Contaacct, <br /> fj <br /> �� Overfill prevention: <br /> Monitoring Panel: iping system: echanical ❑Audible/visual <br /> .i ressurized [I Suction ❑Gravity <br /> Violations: <br /> inspection type: V M1 Rns: 01A2-RPrev ❑M-3 Both <br /> J�Routine onitoring Certification ❑Installation d Other: MVR <br /> VIOLATIONS) HSC=California Health&Safety Code;GCR=California Code of Regulations# Code Section V=Violation;RV=Re eat Violation <br /> l HSC 25284 Petmit to o crate2 CCR 2637 Seconda containment test erFotmed3 CCR 271I b)& c) Current Unified Pro ram Consolidated Fos on file with EHD Facilit and tank form) <br /> 4 HSC 25292.2 Certification of financial res onsibilit and CFO letter <br /> 5 CCR2632 b) Monitorin Pro ram Monitorin &Res onse Plan)is current and a roved b the local a enc .6 CCR 2712 i) Monitorin lan is onsite. M <br /> 7 CCR 2712 b Maintenance&monitinring records <br /> 8 CCR 2643 d) Dail monitorin of suction i in-( re-Janna , 1, 1984) <br /> 9 HSC 25292.1 UST s stem is o crated to revent unauthorized release (M1) <br /> 1 f) CCR 2632 c) 2) UST monitorin s stem is resent (MI)l) <br /> 1 l CCR 2630 d UST s stem monitorin a ui ment is to erl located to detect a leak (MI) <br /> 12 HSC 25291 b) UST s stem monitorin a ui ment iso erational M1 <br /> 13 CCR 2636 I Continuous monitorin s stem for underground pi2i.ng&UDC is present <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) l All releases in secunda i in flow to a collection sump (M 1) <br /> 17 HSC 25291 t Line leak detector s)are installed (M2) <br /> 18 CCR 2635 b) I) S iii container M2) <br /> 19 CCR 2635 b 2 Overtill --.tion s stem <br /> 20 CCR 2636(a) Conventional suction i in shall have continuous monitorin &2°containment <br /> 21 HSC 25291 (e) Water in 21 containment analyzed&properly disposed of (M 1) <br /> 22 CCR 2650 Record'--'---`--of unauthorized releases <br /> 23 CCR 2715 Desi nate,'O erator:(a)Statement from UST owner; (c-c)Monthly inspection; f) Employee training <br /> 24 CCR2638 a) Annual monitoring certification (Mi) <br /> 25 CCR 2638 a) Annual line leak detector test <br /> 26 HSC 25284.2 Annual-ill containment testin (M 1) <br /> 27 CCR 2636(f)(4) Annual line tightness test (M2) <br /> 28 CCR 2661 t) R1,113air for tank/ i in has had ti htness test <br /> 29 CCR 2643 e) Biennial tightness test of gravity piping(pre-January 1, 1984) (Mi) <br /> 30 CCR 2643 d) Triennial line test for conventional suction i in (pre-January1, 1984) <br /> 31 HSC 25292.5 Double walls stem located within 1000' of public well-ELD <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 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) [lie al abandonment of UST system <br /> 38 Other: UIC <br /> FHD INSPECTOR: PHONE: �� <br /> Septic system: <br /> Serves 2!20 people/day <br /> I -Receives other than sanitary waste <br /> RECEIVE t + TITLE: (ilv <br /> Other dis osalmethods: <br /> Ivy " Dry <br /> wells/French Drains <br /> L <br /> EHD 23-02-002 REV 05107 <br />