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SAN JOAQUIN COUNTY 4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT"*4 <br /> 304 East Weber Avenue,3rd Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Far:(209)468-3433 Web:www.sjgov.ore/ehd <br /> UNDERGROUND STORAGE TANK ST PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> V 4--t'g t N IZ oS <br /> Facility address: A. UST# (/ <br /> ./ 1 O q'M�^I -9 • V j/c-rJ - Product _I J <br /> Faci' c: (� Title: Phone: <br /> AA4AAoY-Aev I& <br /> Monitoring Panel: Piping system: Overfill prevention: <br /> ❑Pressurized ❑Suction ❑Gravity ❑Mechanical ❑Audible/visual <br /> Inspection type: Violations: <br /> Routine ❑Monitoring Certification ❑Installation ❑Other: ❑MI-RDetect ❑M2-RPrev ❑M-3 Both <br /> # Code Section VIOLATION(S) HSC=California Health&Safety Code;CCR=Califomia Code of Regulations V R <br /> V=Violation;RV=Repeat Violation V <br /> I HSC 25284 Permit to operate <br /> 2 CCR 2637 Second 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 c 2 D Monitoring&response plan is current and filed with the local agency <br /> 6 CCR 2712 i Monitoring&response plan is onsite <br /> 7 1 CCR 2712 Maintenance&monitoring records Ml <br /> 8 CCR 2643 d Daily rnionitoring of suction piping(prit-Jainuary, 1, 1984 <br /> 9 HSC 25292.1 UST s stem is operated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present Ml <br /> 11 CCR 2630 itUST system monitoring equipment is properly located to detect a leak Ml <br /> 12 HSC 25291 UST system monitoring equipment is operational M2 <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping&UDC is present Ml <br /> 14 CCR 2631 a containment is product tight <br /> 15 HSC 25291 (a)(2) Secondary containment for UST is tight <br /> 16 1 CCR 2636(c)(1) All releases in secondary pipingflow to a collection sump <br /> 17 HSC 25291 Line leak detector(s)are installed Ml <br /> 18 CCR 2635 1 Sill container (M2 <br /> 19 CCR 2635(b)(2) Overfill prevention system M2 <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&20 containment <br /> 21 HSC 25291 (c) Water in 20 containment analyzed&properly disposed of <br /> 22 CCR 2650 Recordin nt <br /> �ng of unauthorized releases Ml <br /> 23 CCR 2715 DesignatedOperator: a Statement from UST owner; (c-e)Monthly inspection; Employee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 j 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 Ml <br /> 28 CCR 2661 Ru 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 Ml <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 Permit to temporarily close UST system <br /> 35 HSC 25298 c Permit to close UST system <br /> 36 HSC 25299(aX9) Disabling leak detection devices <br /> 37 HSC 25298 a Illegal abandonment of UST system <br /> 38 1 Other: <br /> EHD IN R: A,,� PHO E: _ zv �v UIC <br /> bSmile <br /> Serves 210 people/day <br /> RECE E BY: TITLE: _.Receives other than sanitary waste <br /> Other disposal methods' <br /> t -Dry wells/French Drains <br /> EHD 23-02-002 <br />