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PUB" ; HEALTH SERVICES SAN JOAQU'�OUNTY DATE — ENVIRONMENTAL HEALTH DIVISRU PR# 304 E. Weber Ave., Third Floor, Stockton, CA 95202 PAGE (209) 468-3420 UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT Facility NanneL' &^ 04,'r\6. Facility Addresss Facilty Contact (V�(1 , �� Title U: K� Phone 3S UST# Product _ UST#_'Product_CL� _UST#_Product UST#_Product Overfill Prevention: AudibleNisual echanical Monitoring Panel: _�JLrj a �c lkL Piping System: Gravity cr sure> Suction Violations: roar=, Major Automatic Pump Shut Down Satisfies CCR 2636 (g): a No Dispenser Pan: No INSPECTION TYPE: :fiouti ertificatipn.'Complaint Install Removal Repair/Upgrade COMPANY NAME:'0 < 1 T ECHNICIAN NAME: - , " PHONE: j 3a 7 S _ 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 19 ./ CCR 2712 (i) Monitoring & response plan 2 CCR 2637 Secondary cont testing (6 is on site month/36 month) 20CCR 2712 (b) Maintenance & monitoring 3 CCR 2711(b) & (c) Current State Forms A& B records 4 /HSC 25292.2 Certification of financial 21 CCR 2636 (f)(4) Annual line tightness test responsibility and letter from 22=CCR 2630 (d) Annual line leak detector test chief financial officer 23 ✓CCR 2630 (d) Annual monitoring 5 CCR 2630 (d) Continuous monitoring certification system for UST system 24CCR 2643 (d) Daily monitoring of suction 6 _CCR 2636 (c)(1) All releases in secondary piping that is not piping flow to a collection continuously monitored sump 25 CCR 2643 (d) Triennial tightness test of 7_ HSC 25291 (e) Water in secondary (20) cont suction piping that is not 8 HSC 25291 (f) Automatic line leak continuously monitored detector(s) 26 CCR 2643 (e) Biennial tightness test of 9 CCR 2636 (f)(1) Continuous monitoring gravity piping that is not system for underground continuously monitored piping 27CCR 2662 Upgrade requirements for 10 _CCR 2632 (c)(2) Continuous monitoring UST system system for UST 28 CCR 2661 Permit to repair UST system 11HSC 25291(a)(2) Secondary containment for 29 HSC 25286 (a) Permit to alter monitoring UST is tight system 12CCR 2636 (f)(1) Continuous monitoring 30HSC 25298 (a) Illegal abandonment of UST system for dispenser system system 13CCR 2635 (b)(1) Spill container 31 HSC 25298 (b) Permit to temporarily close 14CCR 2635 (b)(2) Overfill prevention system UST system 15CCR 2631 (a) Primary containment is 32 HSC 25298 (c) Permit to close UST system product-tight 33 HSC 25291 (e) Water in 20 cont analyzed 16 HSC 25292.1 UST system is operated to and properly disposed of prevent unauthorized release 34 CCR 2640 (e) Single wall component within 17CCR 2650 Recording/reporting 1000' of Public Well, no ELD unauthorized release 36 _CCR 2635(a)(2)(A)Cathodic protection testing 18 >/CCiR 2632 (d) Monitoring & response plan 35 Violation(s) not listed above PECTOR: EHD INSPHONE: L16 p - gn RECEIVED BY: TITLE: PHONE: 133 - / UNITII WSTNNSP(rev 12/19/01)