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SAN JOAQUIN COUNTY <br /> OENTNVIRONMENTAL HEALTH DEPARTMit <br /> 304 East Weber Avenue,3'd Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(249)468-3433 Web:www.s• ov.or ehd <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Designated Operators inspection Date: <br /> Facility'names <br /> UST# <br /> Facility address: —7 } / <br /> jtr/ d � [/ — �b Product <br /> Facility Contact: Title: Phone: / <br /> Piping system: Overfill prevention: <br /> M nitoring.Panel. p g y ,_,/ <br /> © ❑Pressurized Suction ❑GravityIdMechanical ❑Audible/visual <br /> Violations: <br /> In ction type: <br /> Routs`ne Monitorin Certification 0 Installation ❑Other: ❑MI-RDetect ❑M2-RPrev F M-3 Both <br /> L2LCCR <br /> Code Section VIOLATION(S) HSC=Califomia Health&Safety Code;CCR=California Code of Regulations <br /> V R <br /> V=Violation;RV—Repeat Violation <br /> C 25284 Permit too erate <br /> 2637 Seconda containment test erformed <br /> R 2711 b & c Current Unified Program Consolidated Forms on file with EHD(Facility and tank form <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632 c 2 D Monitoring&response plan is current and filed with the local agency <br /> 6 CCR 2712(i) Monitorin &res nse plan is onsite M 1) <br /> 7 CCR 2712 b Maintenance monr orm recor <br /> 8 CCR 2643(d Dail monitoringof suction i in re-Jams 1, 1984) <br /> 9 HSC 25292.1 UST system iso erated to Prevent unauthorized release (fill) <br /> 10 CCR 2632(c)12 UST monitorings stem is resent <br /> 1 I CCR 2630 d UST system monitoringequipment is properly located to detect a leak (M171) <br /> 12 HSC 25291 UST system monitoringequipment isoperational M2) <br /> 13 CCR 2636(f)(1) Continuous monitoring system for underground piping&UDC is present (M 1) <br /> 14 CCR 2631 a Primary containment is product ti ht <br /> 15 HSC 25291 (a)(2) Secondary containment for UST is tight <br /> 16 CCR 2636{c) ] All releases in secondary pipingflow to a collection sumpMI <br /> 17 HSC 25291 Line leak detector(s)are installed (MZ <br /> 18 CCR 2635(b)(1) Spill container M2) <br /> 19 CCR 2635 b 2 Overfill prevention system <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&properly disposed of <br /> 22 CCR 2650 Recordin re ortin of unauthorized releases MI <br /> 23 CCR 2715 Designated Operator:(a Statement from UST owner, (c-e)Monthly inspection;(f)Employee training <br /> 24 CCR 263$ a Annual monitoring certification (M1) <br /> 25 CCR 2638(a) Annual fine leak detector test <br /> 26 HSC 25284.2 Annuals ill containment testingMI <br /> 27 CCR 2636 4 Annual line tightness test (M2 <br /> 28 CCR 2661 (f) Repair for tank/piping has had ti htness test <br /> 29 CCR 2643 e Biennial tightness test of gravity piping{ re-Janua 1, 1984 MI <br /> 30 CCR 2643 d Triennial line test for conventional suction piping( re-Jams 1, 1984 <br /> 31 HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to re air UST system <br /> 33 HSC 25286 a Permit to alter monitorino 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) Illegal abandonment of UST system <br /> 38 Other: <br /> EHD 3NSPE OR- PHONE: (11Cr � [1,f Septic system; <br /> I v Serves 220 people/day <br /> rs—�r <br /> LVEDRfeEBY: TITLE: I Receives other than sanitary waste <br /> Other disposal methods: <br /> Dry welts/French Drains <br /> t -7 t <br /> F.FID 23-02-002 <br />