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SAN JOAQUIN COUNTY <br /> 9NVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:M".s' ov.or /ehd <br /> UNDERGROUND STORAGE TANK ST PROGRA <br /> Facility name: M INSPECTION REPORT <br /> 1 Designated Operator: Inspection Date: <br /> t�oL �jYry11G✓�i n <br /> Facility address: <br /> I rayl fvlc�I ,(e ?h (0-7 <br /> I tJ 11 s G fly,l r UST# <br /> Facility Contact: Title: Product {r <br /> Phone: � <br /> lonitoring Panel: Piping system: �� r <br /> St7 d Pressurised Overfill prevention: <br /> Inspection type: Suction 0 Gravit <br /> Mechanics[ 1.7 Audible/visual <br /> outine Mortitorin CertificationViolations: <br /> 11 Installation 5 Other: C7 Ml-RDetect �- <br /> M: RPrev L M-3 Both <br /> # Code Section VIOLATION(S) HSC�Califomia Health&Safety Code;CCR=California Code of Regulations V R <br /> 1 HSC 25284F nit too erste V=Violation;RV=R eat Violation V <br /> 2 CCR 2637 Secondary containment test erfortned <br /> 3 CCR 2711 b & c Current Unified Pro Consolidated Forms on file with EHD fo <br /> 4 NSC 25292.2 Certification of financial responsibility and CFO letter Facih and tank rm) <br /> 5 CCR 2632 b) Monitoring Pro am Monitorin &Res once Plan is current and approved by the local a enc . <br /> 6 CCR 2712(i) Monitoring plan is onsite. <br /> 7 CCR 2712 b) Maintenance&monitoring records <br /> 8 CCR 2643 d) Dail mont ringofsu-ctionpit)ing(i)rc-lanuary 1, 1984) <br /> 9 HSC 25292.1 UST s stem is operated to Drevent unauthorized release <br /> 10 CCR 2632(c(2) UST monitorin s stem is present <br /> I 1 CCR 2630 d) UST s stem monitorin a ui ment is properly located to detect a leak (141) <br /> 12 HSC 25291 (b) UST s stem monitoring a a ment isoperational (M1) <br /> 13 CCR 2636 f) 1) Continuous monitoring s stem for underground piping& UDC is present (M2) <br /> 14 CCR 2631 (a) Prim containment is roduct tight Ml) <br /> 15 HSC 25291 a 2 Second containment for UST is ti ht <br /> 16 CCR 2636 c)(1) All releases in secunda 2iping'low to a collection sum <br /> 17 HSC 25291 Line leak detecto s)are installed <br /> 18 CCR 2635 b(1) Sill container (M1) <br /> 19 CCR 2635 b)2) OverFll revention system (M2) <br /> 20 CCR 2636(a) Conventional suction i"Di­7 shall have continuous monitorin &2°containment (M2) <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&pro erly disposed of <br /> 22 CCR 2650 Recordin ortin of unauthorized releases <br /> 23 CCR 2715 Desi noted erator:(a)Statement from UST owner; c-e Month] ins ection (' in to ee trainin Ml) <br /> 24 CCR 2638 fal Annual monitorina certification <br /> 25 CCR 2638(a) Annual line leak detector test <br /> 26 HSC 25284.2 Annuals ill containment testing (MI) <br /> 27 CCR 2636 f)4) Annual line dig-htness test <br /> 28 CCR 2661 f) R----for tank/ iPing has had tightness test MI) <br /> 29 CCR 2643 e) Biennial ti htness test ofavis i in re-Janus 1, 1984) (M2) <br /> 30 CCR 2643 d) Triennial line test for conventional suction pipin ( re-Janu 1, ]984) <br /> 31 HSC 25292.5 Double walls stein located within 1000'of ublic well-ELD (M1) <br /> 32 CCR 2661 Permit to repair UST system <br /> 33 HSC 25286 a) Permit to alter monitorin -.-m <br /> 34 HSC 25298(b) Permit to tem o jlX close UST system <br /> 35 HSC 2529$ c Permit to close UST system <br /> 36 HSC 25299(a) 9) Disablin leak detection devices <br /> 37 HSC 25298 a) alae al abandonment of UST system <br /> 38 Other: <br /> L111)INSPECTOR: PHONE: <br /> a" u UIC <br /> '1Q 1 I ej Sepiic system• <br /> RECEIVED BY 1d 1 Serves?20 people/day <br /> TITLE: Receives other than sanitary waste <br /> Other disposal methods- <br /> Dry Drains <br /> EHD 23-02-002 REV 05/07 <br />