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DATE <br /> SAN JOAQUIN COUNTY PR# Z3 <br /> Al"VIRONMENTAL HEALTH DEPARTM . PAGE / <br /> 304 E. Weber Ave.,Third Floor, Stockton, CA 95202 <br /> (209)468-3420 D <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> ,r �� Ssc+,cr <br /> Facility Name L SSac e'IrK Facili#� Address 75 Z� <br /> Facilty Contact Ol Title () CQ, x d l Phone# <br /> UST# [ Product UST# Z Product UST#Product UST# Pr . <br /> Overfill Prevention: ❑AudibleNisual •❑ Mechanical Monitoring Panel: L�= Zed <br /> Piping System: ❑ Gravity ❑ Pressure ,❑ Suction Violations: ❑ Minor ❑ Major <br /> Automatic Pump Shut Down Satisfies CCR 2636 ❑Yes❑ No Dispenser Pan: ,❑ Yes ❑ No <br /> INSPECTION TYPE: 4 outine ❑Monitoring Certification ❑Complaint ❑install ❑Removal aRepair/Upgrade <br /> COMPANY NAME: TECHNICIAN NAME: PHONE: <br /> VIOLATION(S) <br /> The above facility is not in compliance with the following section(s) of Health & Safety Code (HSC) and/or <br /> California Code of Regblationss (/CCR'2' 712 <br /> CCR): <br /> 1 HSC 25284 Permit to operate 20 (b) M�tenance & monitoring <br /> 2 CCR 2637 Secondary cont testing (6 recorc 7 <br /> month/36 month) 21 CCR 2636 (f)(4) Annual line tightness test <br /> 3 CCR 2711(b) & (c) Current State Forms A& B 22 CCR 2630 (d) Annual line leak detector test <br /> HSC,25292.2 Certification of financial 23:ZCCR 2630 (d) Annual monitoring certification <br /> D 3 responsibility and letter from 24 CCR 2643 (d) Daily monitoring of suction <br /> chief financial officer piping that is not continuously <br /> 5 CCR 2630 (d) Continuous monitoring system monitored <br /> for UST system 25 CCR 2636 (a) Conventional suction piping <br /> 6 CCR 2636 (c)(1) All releases in secondary piping shall have continuous <br /> flow to a collection sump monitoring &20 containment <br /> 7 HSC 25291 (e) Water in secondary(20) cant 26 CCR 2643 (e) Biennial tightness test of gravity <br /> 8 HSC 25291 (f) Automatic line leak detector(s) piping that is not continuously <br /> 9 CCR 2636 (f)(1) Continuous monitoring system monitored <br /> for underground piping 27 CCR 2662 Upgrade requirements for UST <br /> 10 CCR 2632 (c)(2) Continuous monitoring system system <br /> for UST 28__ZCCR 2661 Permit to repair UST system <br /> 11 HSC 25291(a)(2) Secondary containment for 29 HSC 25286 (a) Permit to alter monitoring <br /> UST is tight system <br /> 12_ZCCR 2636 (f)(1) Continuous monitoring system 30 HSC 25298 (a) Illegal abandonment of UST <br /> for dispenser system system <br /> 13 CCR 2635 (b)(1) Spill container 31 HSC 25298 (b) Permit to temporarily close UST <br /> 14 CCR 2635 (b)(2) Overfill prevention system system <br /> 15 CCR 2631 (a) Primary containment is product- 32 HSC 25298 (c) Permit to close UST system <br /> tight 33 HSC 25291 (e) Water in 20 cont analyzed and <br /> 16 HSC 25292.1 UST system is operated to properly disposed of <br /> prevent unauthorized release 34 CCR 2640 (e) Single wall component within <br /> 17 CCR 2650 Recording/reporting 1000' of Public Well, no ELD <br /> unauthorized release 35 CCR 2635(a)(2)(A)Cathodic protection testing <br /> 18 ,CCR 2632 (d) Monitoring & response plan 36 H&SC 25299(a)(9)Disabling leak detect. devices <br /> 19 CCR 2712 (i) Monitoring &response plan is 37 Violation(s) not listed above <br /> d [� on site <br /> EHD INSPECTOR: PHONE: vy� <br /> RECEIVED BY: TITLE: <br /> UNMIVUSTANS?(rev 724102) <br />