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SAN JOAQUIN COUNTY s'tl <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 Far:(209)468-3433 Web:www.sigov.org/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> b,Ij46Ii6. QA <br /> Facility address: <br /> UST# , <br /> 164-10 ( A�1tRoP <br /> Product <br /> Facility Contact: v Title: Phone: <br /> Monitoring Panel: Piping system: Overall prevention: <br /> V Vpressumed ❑suction ❑Gravity "echanical ❑Audible/visual <br /> Inspection type: // Violations: <br /> (]YM <br /> li?Routine onitorin Certification ❑Installation ❑Other: ❑MI-RDetect ❑M2-RPrev ❑M-3 Both <br /> # Code Section VIOLATIONS) HSC=Califomia Health&Safety Code;CCR=California Code of Regulations V R <br /> V=Violation; RV=R t Violation V <br /> I HSC 25284 Permit to operate <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 form <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632 6 Monitorin Program(Monitoring&Response Plan is current and approved by the local agency. <br /> 6 CCR 2712 i Monitoring Ian is onsite. <br /> 7 1 CCR 2712 6 Maintenance&monitoring records Ml <br /> 8 CCR 2643 d Daily monitoring of suction piping(pre-January, I, 1984 <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present Ml <br /> I t CCR 2630 d UST astern monitoring equipment is properly located to detect a leak Ml <br /> 12 HSC 25291 6 UST system monitoring equipment is operational M2 <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping&UDC is present MI <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 detecto s are installed Ml <br /> 18 CCR 2635(b)(1) Spill container M2) <br /> 19 CCR 2635(b)(2) Overfill prevention system My <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/rcporting of unauthorized releases MI <br /> 23 1 CCR 2715 Designated Operator. a Statement from UST owner; (c-e)Monthly inspection; Employee tminin <br /> 24 1 CCR 2638 a Annual monitoring certification <br /> 25 1 CCR 2638 a) Annual line leak detector test (M l) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 4 Annual line lightness test Ml <br /> 28 CCR 2661 Repair for tank/piping has had tightness test (M2 <br /> 29 CCR 2643 a Biennial fi hmess test of gravity pipingre-Janus 1, 1984 <br /> 30 CCR 2643 d) Triennial line test for conventional suction piping(pre-January1, 1984) M1) <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 1 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) I Disabling leak detection devices <br /> 37 HSC 25298 a Illegal abandonment of UST system <br /> 38 Other: <br /> EHD INSPECTOR: /y� PHONE: UIC <br /> M r 7 l r�/✓� 4 G — 3 �� otic system: <br /> Serves>_20 peoplciday <br /> RECEIVEDBY: " TITLE: -Receives other than sanitary waste <br /> Mlvbl— Other disposal methods: <br /> wells/French drains <br /> EHD 23-02-002 REV 05/07 <br />