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• SAN JOAQUIN COUNTY • <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sieov.org/ehd <br /> UNDERGROUND STORAGE TANK ST PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> nr� <br /> 3�6 Q � 6k <br /> Facility address: UST# , <br /> `�-t3ti3 iS 1 a9 1tc�„ CA q��, �ob qq Qq p <br /> S�Product Product � /11 /O p7 <br /> Facility Contact: Title: Phone: <br /> le eh'Zw 6'5'xa' 3g3-2511 <br /> Monitoring Panel: Piping system: Overfill prevention: <br /> 10 Pressurized ❑Suction ❑Gravity Mechanical ❑Audible/visual <br /> inspection type: Violations: <br /> Id Routine Id Monitoring Certification ❑Installation ❑Other: IA MI-RDetect ❑M2-RPrev ❑M-3 Both <br /> # Code Section <br /> VIOLATION(S) HSC=California 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 form <br /> 4, HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632 b Monitoring Program(Monitoring&Response Plan)is current and approved by the local agency. <br /> 6 CCR 2712 i) Monitoring Ian is onsite. <br /> 7 CCR 2712 6 Maintenance&monitoring records Ml <br /> 8 CCR 2643 d Daily monitoringof suction piping(pre-January, 1, 1984 <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 –EC—R2632(c)(2) UST monitoring system is present (Ml) <br /> I 1 CCR 2630 d UST system monitoring equipment is properly located to detect a leak M 1) <br /> 12 HSC 25291 b UST system monitoring equipment isoperational (M2) <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping&UDC is present Ml <br /> 14 CCR 2631 a Primary containment is product tight <br /> 15 1 HSC 25291 (a)(2) Smondary 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 Ml <br /> 18 CCR 2635(b)(1) Sill container (M2) <br /> 19 CCR 2635(b)(2) Overfill preventions stem 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 Recording/reportingof unauthorized releases Ml) <br /> • 23 CCR 2715 DesignatedOperator: Statement from UST owner; (c-e)Monthly inspection; 0 Employee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638 a) Annual line leak detector test (M1) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 4 Annual line tightness testMI) <br /> 28 CCR 2661 Repair for tank/pipinghas had tightness test (M2) <br /> 29 CCR 2643 a Biennial tightness test of gravity piping(pre-January I, 1984) <br /> 30 CCR 2643 d) Triennial line test for conventional suction piping(pre-January 1, 1984) (MI) <br /> 31 1 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 25292,21(9) Disablin leak detection devices <br /> 37 HSC 25298 a) Ille al abandonment of UST system <br /> 38 Other: <br /> END IN O • PHONE: 9151 <br /> UIC <br /> /� Seotic sys[em: <br /> 9 Serves>20 people/day <br /> RECEIVED BY: TITLE:C,./'�/Y� Receives other than sanitary waste <br /> F� 09 Other l methods <br /> Dry wells/French <br /> /J (� wells/French Drams <br /> EHD 23-02-002 REV 05/07 <br />