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"1%a/ SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: vvww.sjgov.org/ehd <br />\ <br />4! - - WTaTINWIQ�D/ TTt n crrnn Ar_F TANIC aTCTI PROGRAM INSPECTION REPORT <br />Vl\LLJ�V 1�V va.v ✓ � � — �— --- — <br />Designated Operator: <br />ln,prnimn Date: <br />Facility name: <br />�E1 # R I rtia'f <br />iASvr <br />Facility address; <br />IIST # <br />Product <br />Facility Contact: <br />Title: Phone: <br />75 <br />;-( <br />(A)0 <br />tz <br />Ft�t 5 Ro`t <br />E�iu ortw. s— ti�faR . �,3-I S', <br />, <br />Monitoring PaSA net.. <br />Piping system: <br />O,t,verfill prevention: <br />'i �S % i <br />❑Pressurized uction GravityAMechanical <br />❑Audibleivisual <br />Inspection type: <br />violations: <br />Routine Monitoring <br />Certification [I Installation ❑Other: ❑MI-RDetect 0M2-RPrcv <br />M1I-pito'„ <br />v Rte' <br />HSC 1'alifnmia Health & Safety Code; CCR=Caahfornia Code of Regulations <br />_ <br />ection <br />V=Violation: RV=Re eat Violation <br />! - <br />Permit tooperate <br />"2529VIOLATIONS) <br />Seconds containment test performed <br />b & c) <br />Current Unified Pro am Consolidated Forms on file with EHD (Facilityand tank form) <br />.2 <br />2.2 <br />Certification of financial res onsibilit and CFO lette(c)(2 <br />D) <br />Vinnit.ring & res onse Ian is current and filed with the local agency <br />6 CCR 2712 i <br />Monitoring & res onse plan is onsite <br />_ <br />7 CCR 2712 <br />Maintenance & monitoring records <br />(M1) <br />8 CCR 2643 d <br />Daily monitoring of suction piping (pre-januLry, 1, 1984 <br />-- <br />9 HSC 25292.1 <br />UST system isoperated to Eevent unauthorized release <br />10 CCR 2632 c 2 <br />UST monitoring system is present <br />(M 1) <br />I I CCR 2630 (d) <br />UST system monitoring equipment is properly located to detect a leak <br />(NII) <br />12 HSC 25291 6 <br />UST system monitoring equipment isoperational <br />M2) <br />13 CCR 2636 (f)(1) <br />Continuous monitorin s stem for underground piping & UDC is present <br />14 CCR 2631 a <br />Primary containment is product tight <br />15 HSC 25291 (a)(2) <br />Secondary containment for UST is tight <br />_ <br />16 CCR 2636 (t)(1) <br />All releases in secondary pipingflow to a collection sum <br />_ <br />17 HSC 25291 (f) - <br />Line leak detector(s) are installed <br />(M 1) <br />18 CCR 2635 1 <br />Spill container <br />M2 - <br />19 CCR 2635 (b)(2) <br />Overfill prevention system <br />(M2) <br />20 CCR 2636 (a) <br />Conventional suction Riping shall have continuous monitoring & 2° containment <br />5291 (e) <br />Water in 2° containment analyzed & pro erI disposed of <br />650 <br />Recording/reportingof unauthorized releases <br />M 1) _. <br />715 <br />Designated Operator: (a) Statement from UST owner; (c -e) Monthlyinspection; (f) Employee rrainin <br />638 a) <br />Annual monitoringcertification---�� <br />638 (a) <br />MCCR2661(t) <br />Annual line Teak detector test <br />(MI) <br />5284.2 <br />Annuals ill containment testing <br />-- <br />636 (f)(4 <br />Annual line tightness test <br />661 <br />Repair for tank/piping has had tightness test <br />M2) <br />29CCR 2643 (e) <br />Biennial tightness test of gravity pipingre-Janus 1, 1984)_ <br />30 CCR 2643 d <br />Triennial line test for conventional suctioni in re -Januar 1, 1984) <br />MI) <br />31 HSC 25292.5 <br />Double walls stem located within 1000' of public well-ELD <br />32 CCR 2661 <br />Permit to repair UST system <br />stem33 <br />33 HSC 25286 (a) <br />Permit to alter monitoring system <br />- <br />34 HSC 25298 (b) <br />Permit to temporarily close UST system <br />35 HSC 25298 (c) <br />Permit to close UST system <br />- 7- <br />36 HSC 25299 (a 9 <br />]§ <br />Disablin leak detection devices <br />-- <br />37 HSC 25298 (a) <br />Illegal abandonment of UST system <br />-- <br />38 1 Other: <br />EHD INSPECTOR: <br />PHONE: <br />Septic system <br />UIC <br />I'IC <br />Serves ?20 people!dag <br />Receives other than San AUT% <br />RECEIVED BY: <br />TITLE: <br />�. ;p <br />Other disposal methods: <br />' ,h _...y- <br />'Dry wells/French Drains <br />EBD 23-02 <br />