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SAN JOAQUIN COUNTY <br /> '—�-NVIRONMENTAL HEALTH DEPARTMENT lame <br /> 304 East Weber Avenue,3"Floor,Stockton,CA 95202-2708 <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: I Inspection Date: <br /> i <br /> Facility address: UST# <br /> t `r Product <br /> Facility Contact: Title: Phone: <br /> Monitoring Panel:/ Piping system: Overfill prevention: <br /> /( n Pressurized ❑suction ❑Gravity ❑Mechanical ❑Audible/visual <br /> Inspection type: , Violations: <br /> / <br /> ''Routine IJ Monitoring Certification ❑Installation ❑Other: ❑MI-RDetect ❑M2-RPrev ❑M-3 Both <br /> # Code Section <br /> VIOLATIONS) HSC=Califomia Health&Safety Code;CCR=Califomia Code of Regulations V R V=Violation;RV=Re eat Violation V <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment teat 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 CCR 2712 6 Maintenance&monitoring records MI <br /> 8 CCR 2643(d) Daily m nitoring of suction piping(pre-January, 1, 1984 <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present (MI) <br /> I I CCR 2630 d UST system monitoring equipment is properly located to detect a leak Mt <br /> 12 HSC 25291 UST system monitoring equipment isoperational M2) <br /> 13 CCR 2636, (1 I Continuous monitoring system for underground piping&UDC is, eM. MI <br /> 14 WX11(a) YTSTm-eyontmmnt 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 pipingHow to a collection sum <br /> 17 HSC 25291 Line leak detectors)are installed MI <br /> 18 CCR 2635(b)(1) Spill 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 (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 Zine 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 f) Repair for tank/piping has had tightness test (M2 <br /> 29 CCR 2643 a Biennial tightness test of gravity piping(pre-January 1, 1984 <br /> 30 CCR 2643(it) 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(b) Permit to temporarily close UST system <br /> 35 HSC 25298(e) 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 /> EHD INSPECTOR: PHONE: UIC <br /> Septic system: <br /> Serves>_20 people/day <br /> RECEIVED BY: TITLE: Receives other than sanitary waste <br /> Other disposal methods: <br /> Dry wells/French Drains <br /> EHD 23-02-002 <br />