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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.s4gov.org/ehd <br />U 1N 11L' KhKV U 1N 0 J 1 V KAh1S I AIN At U01) YKV hKA1V1 11V J YEl, 1 1 V 1N KL' r V K I <br />Facilit name: Designated Operator: Inspection Date: <br />[Facility <br />ciil/liitty address: 1�j/�._'� (^ ^} f� UST # , <br />Conta C Title: Phone: - <br />o�vr. 333-za7 %91- <br />MonitoringtPanel: icing system: Overfill prevention: <br />Inspection type: ��nn� Violations: <br />40 Routine CTAfonitorin Certification ❑Installation 11 Other: 1-RDetect Ll M2-RPrev 11 M-3 Both <br /># Code Section <br />VIOLATIONS) HSC=Califomia Health & Safety Code; CCR=California Code of Regulations V R V=Violation; RV=Repeat Violation V <br />I HSC 25284 1 Permit tooperate <br />2 1 CCR 2637 I Secondary containment test performed -IA-m <br />�I <br />20 1 CCR 2636 (a) I Conventional suction piping shall have continuous monitoring& 20 containment <br />21 HCSC 25291 (e) Water in 20 containment analyzed & properly disposed of <br />22 CR 2650 1 Recording/reporting o authorized releases Ml <br />23 . CCR 2715 r. a Designated Operator. Statement from UST owner: c -e Monthlv inspection: (t) Emplovee training - -M <br />Repair for tank/piping has had tightness test <br />Biennial tightness test of gravity pipingre <br />Triennial line test for conventional suction t <br />Double walls stem located within 1000' of <br />Permit to repair UST system <br />Permit to alter monitoring system <br />Permit to temporarily close UST system <br />Permit to close UST system <br />1)I Disabling leak detection devices <br />Illegal abandonment of UST system <br />PHj <br />BY: <br />EHD 23-02-002 REV 05/07 <br />TITLE: /f <br />Sernic system: <br />Serves 220 people/day <br />- Receives other than sanitary waste <br />Other disposal methods: <br />Dry wells/French Drains <br />