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SAN JOAQUIN COUNTY DATE —Z �JVIRONMENTAL HEALTH DEPART�T PAGE 304 E. Weber Ave., Third Floor,Stockton, CA 5202 (209)468-3420 UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT Facility Nam 1 i 7�dFacility AddressA%ls rJ LsxJeA1 Pcve_, "Ttztc G4 Facilty Contact h J,yv Title VeC:tDr Phone #_,2j%K5 1 . 0D 1 UST# I Product UST#2ProductQ�.�Q UST#_Product UST#_Product Overfill Prevention: D Audible/Visual &Wechanical Monitoring Panel:�Qy yr Piping System: 11 Gravity G7�ressure ❑Suction Violations:D M1-RDet D M2-Rprev D M3-Both Automatic Pump Shut Down Satisfies CCR 2636 (f)(5): ❑Yes P110 Designated Operator: INSPECTION TYPE: , outine Wonitoring Certification ❑Complaint Dinstall ❑Removal ❑Repair/Upgrade COMPANY NAME: C TECHNICIAN NAME: y PHONE: gpo.( UD•1y VIOLATION(S) The above facility is not in compliance with the following section(s) of Health & Safety Code (HSC)and/or California Code of Regulations (CCR): 1 HSC 25284 Permit to operate 23 CCR 2643 (d) Daily monitoring of suction 2_CCR 2637 Secondary cont. testing piping (pre-1/1/84) 3 CCR 2711(b) & (c) Current State Forms A& B 24 CCR 2636 (a) Conventional suction piping 4=HSC 25292.2 Certification of financial shall have continuous responsibility& CFO letter monitoring & 20 containment 5_CCR 2632 (c)(2) UST monitoring is present (M1) 25 CCR 2643 (e) Biennial tightness test of gravit, 6_CCR 2630 (d) UST system monitoring piping (pre-1/1/84) equipment is properly located.to _ 26 CCR 2643.(d) Triennial line test for detect a leak(M1) conventional suction (pre- 7 CCR 2637(b) UST system monitoring 1/1/84) (M1) equipment is operational (M1) 27 CCR 2661 Permit to repair UST system 8CCR 2636 (f)(1) Continuous monitoring system 28_HSC 25286 (a) Permit to alter monitoring for underground piping & UDC system is present(M1) 29 HSC 25298 (a) Illegal abandonment of UST 9CCR 2636 (c)(1) All releases in secondary piping system flow to a collection sump 30HSC 25298 (b) Permit to temporarily close US- 10 HSC 25291 (f) Line leak detector(s) (M1) system 11_HSC 25291(a)(2) Secondary containment for 31 HSC 25298 (c) Permit to close UST system UST is tight 32 HSC 25292.1 UST system is operated to 12 CCR 2635 (b)(1) Spill container(M2) prevent unauthorized release 13 HSC 25284.2 Annual spill container testing z 33 CCR 2650 Recording/reporting 14 CCR 2635 (b)(2) Overfill prevention system (M2) unauthorized release(M1) 15 CCR 2631 (a) Primary containment is product--_ 34 HSC 25291 (e) Water in 20 cont analyzed and tight properly disposed of 16 CCR 2632 (d) Monitoring &response plan 35 CCR 2640 (e) Single wall component within 17 ✓CCR 2712 (i) Monitoring & response plan is 1 000' of Public Well, no ELD on site 36 CCR 2635(a)(2)(A)Cathodic protection testing & 18 ✓ CCR 2712 (b) Maintenance& monitoring 60 day inspection log (M2) records(M1) 37 H&SC 25299(a)(9)Disabling leak detect. Devices 19 ✓CCR 2636(f)(4) Annual line tightness test 38 CCR 2715(a) Statement from UST owner 20—CCR 2630 (d) Annual line leak detector test 39 CCR 2715(c) Monthly inspection by D.O, (M1) 40 CCR 2715 (f) D.O. trained employees 21 CCR 2630 (d) Annual monitoring certification 41 Violation(s) not listed above 22_CCR 2661 (f) Repair for tank/piping has had tightness test M2 EHD INSPECTOR: PHONE: RECEIVED BY: TITLE: YV Septic Syst D Serves 2 20 persons/day D Receives other than sanitary waste Other Disposal Units Identified: D Dry wells/French Drains ewm kUMt-nnusnusr in we bcna.+9.o .DOC -N5 (act'Cr Fj rs subill f -to, r6f'n-spee,17f7naf angfilvit a+ tftps houeIg safe .