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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, California 95202-3029 Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sjgov.ore/ehd UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT Facility name: V Designated Operator: Designated Inspection Date: Facility address: C?5'Z31. UST# I roduct Facility Contact: I Title: zoP one: Monitoring Panel: aessurized Piping system: ❑ Suction ❑ Gravity Overfill prevention: ❑ Mechanical ible/visual Inspection type: outine onitoring Certification ❑ Installation ❑ Other: Violations: I-RDetect ❑ M2-RPrev ❑ M-3 Both # Code Section VIOLATION(S) HSC—California Health & Safety Code; CCR=Califomia Code of Regulations V R V=Violation; RV=Re eat Violation V I HSC 25284 Permit tooperate 2 CCR 2637 Secondary containment test performed 3 CCR 2711 b) & c Current Unified Program Consolidated Forms on file with EHD(Facility and tank form 4 HSC 25292.2 Certification of financial responsibility and CFO letter 5 CCR 2632 6 Monitoring Program(Monitoring & Response Plan is current and approved by the local agency. 6 CCR 2712 i) Monitoring Ian is onsite. 7 CCR 2712 b Maintenance& monitoring records MI 8 CCR 2643 d) Daily monitoring of suction piping (pre -January, I, 1984) 9 HSC 25292.1 UST s stem isoperated to prevent unauthorized release 10 CCR 2632 (c)(2) UST monitoring system is present (M 1) 1 I CCR 2630 d UST system monitoring equipment is properl located to detect a leak M l 12 HSC 25291 6 UST system monitoring equipment isoperational (M2) 13 CCR 2636 l Continuous monitoring system for underground piping & UDC is present M 1) 14 CCR 2631 a Primary containment is product tight 15 HSC 25291 (a)(2) Secondary containment for UST is tight 16 CCR 2636 (c)(1) All releases in secondary pipingflow to a collection sum 17 HSC 25291 Line leak detecto s are installed M 1) 18 CCR 2635 (b)(1) Spill container (M2) 19 CCR 2635 (b)(2) Overfill prevention system (M2) 20 CCR 2636 (a) Conventional suction piping shall have continuous monitoring & 20 containment 21 HSC 25291 (e) Water in 20 containment analyzed & properly disposed of 22 CCR 2650 Recordingreporting of unauthorized releases Ml) 23 CCR 2715 Designated Operator: (a) Statement from UST owner; (c -e) Monthly inspection; f) Employee trainin 24 CCR 2638 a Annual monitoring certification 25 CCR 2638 (a) Annual line leak detector test (M D 26 HSC 25284.2 Annuals ill containment testing 27 CCR 2636 4 Annual line tightness test Ml 28 CCR 2661 Repair for tank/piping has had tightness test M2) 29 CCR 2643 a Biennial tightness test of gravity pipingre-Janus 1, 1984 30 CCR 2643 d) Triennial line test for conventional suction piping (pre -January I, 1984) MI 31 HSC 25292.5 Double walls stem located within 1000' of public well-ELD 32 CCR 2661 Permit to repair UST system 33 HSC 25286 a Permit to alter monitoring system 34 HSC 25298 b) Permit to temporarily close UST system 35 HSC 25298 c Permit to close UST system 36 HSC 25299 (a)(9) Disabling leak detection devices 37 HSC 25298 a) Illegal abandonment of UST system _ 38 Other: EHD INSPECTOR: PHONE:' I A t� I V CJ V UIC Serie system: - Serves 220 people/day Receives other than sanitary waste Other disposal methods: wells/French mains RECEIVED BY: TITLE: EHD 23-02-002 REV 05/07