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t SAN JOAQUIN COUNTY <br /> *NVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sieov.ore/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> V pet-&-6 F,Ae - C'au' CW (o-5-0-7 <br /> /Facility address: UST FI •L 3 t�Y <br /> -t,�-�S l mss""— •s"� Product �_ l I VJL- <br /> Facility Contact: Title: Phone: <br /> A'� 9. 0816) 316_66$j <br /> ZVPanel: Piping system: Overfill prevention: <br /> 35o XNessunad ❑Suction ❑Gravity ❑Mechanical Audible/visual <br /> Inspection type: Violations: <br /> ❑Routine ❑Monitoring Certification Installation 11 Other: ❑MI-RDetect ❑M2-RPrev ❑M-3 Both <br /> # Code Section <br /> VIOLATION(S) HSC=Califomia Health&Safety Code;CCR=Califomia Code of Regulations V R V=Violation;RV=R eat Violation V <br /> I HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test performed <br /> 3 CCR 2711 b & c Current Unified Program Consolidated Forms on file with EHD(Facility and tank fomt <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632 b Monitoring Program(Monitoring&Response Planis current and approved by the local agency. <br /> 6 1 CCR 2712 i) Monitoring plan is onsite. <br /> 7 1 CCR 2712 Maintenance&monitoring records Ml <br /> 8 1 CCR 2643 d) Daily monitoring of suction piping(pre-January, 1, 1984 <br /> 9 HSC 25292.1 UST system is operated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present (MI) <br /> 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak Ml <br /> 12 HSC 25291 ) UST system monitoring equipment is operational (MZ) <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping&UDC is present 1) <br /> 14 CCR 2631 a Primary containment is product tight <br /> 15 HSC 25291 (a)(2) Secondary containment for UST is tight <br /> 16 CCR 2636(c)(1) All releases in secondary pipingflow to a collection sum <br /> 17 HSC 25291 Line leak detector(s) are installed MI <br /> 18 CCR 2635(b)(1) Spill container (M2) <br /> 19 CCR 2635(b)(2) Overfill prevention s slim[ M2 <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&20 containment <br /> 21 HSC 25291 (e) Water in 20 containment analyzed&Properly disposed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases Ml <br /> 23 CCR 2715 DesignatedOperator: a)Statement from UST owner; c-e)Monthly inspection;(f)Employee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638 a) Annual line leak detector test Ml) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 4) Annual line tightness test (MI) <br /> 28 CCR 2661 f) Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 a Biennial tightness test of gravity pipingre-Janus 1, 1984 <br /> 30 CCR 2643 d) Triennial line test for conventional suction piping(pre-January1, 1984 (MI) <br /> 31 HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to repair UST system <br /> 33 HSC 25286 a Permit to alter monitoring 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 /> RHD INSPECTOR: PHONE: Septic system:i r/ UIC <br /> 6z — J4 U l 7 Serves>_20 people/day <br /> REC ED BY: TITLE: Cl Receives other than sanitary waste <br /> r. .,. Other disposal methods: <br /> -1 Dry we11s/French Drains <br /> EHD 23-02-002 REV 05/07 <br />