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oPqutry C <br /> SAN JOAQUIN COUNTY <br /> - ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3"1 Floor, Stockton, CA 95202-2708 <br /> o c' Telephone:(209)468-3420 Fax:(209)464-0138 Web:wwwsjgov.org/ehd <br /> q�rFOAN/ <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> Facility address: UST# <br /> 3 b E . �u l` J • Product <br /> Facility Contact: Title: Phone: <br /> NAftk VM-M - <br /> Monitoring((Panel: XZ Piping system: Overfill prevention: ' <br /> TC-5 �tj� Pressurized ❑Suction ❑Gravity ❑Mechanical Audible/visual <br /> Inspection type: Violations: <br /> ❑Routine ❑monitoring Certification nstallation ❑Other: ❑Ml-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=Califomia Health&Safety Code;CCR=California Code of Regulations V R <br /> # Code Sectioe V <br /> V=Violation;RV=Re eat Violation <br /> I HSC 25284 Permit tooperate <br /> 2 CCR 2637• Secondary containment test performed <br /> 3 CCR 2711 (b)& c Current Unified Program Consolidated Fortes 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 1 CCR 2712 i Monitoring&response plan is onsite <br /> 7 CCR 2712(b) Maintenance&monitoring records Ml <br /> 8 CCR 2643 d Daily monitoring of suction piping(pre'.)anua , 1, 1984 <br /> 9 HSC 25292.1 UST system is op crated to prevent una6thorized release <br /> 10 CCR 2632(c)(2) UST monitoringsystem is resent MI <br /> 11 CCR 2630 d UST s stem monitorin equipment is ptoperly located to detect a leak MP <br /> 12 HSC 25291 UST system monitoring equipment is operational M2 <br /> 13 CCR 2636(l)(1) Continuous monitoring system for underground pipinUDC is present M1J <br /> 14 CCR 2631 a Primary containment 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 pipingflow to a collection sum <br /> 17 HSC 25291 Line leak detector(s)are installed MI <br /> 18 CCR 2635 1 Spill container M2 <br /> 19 CCR 2635 2 Overfill prevention system (M2) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases Ml <br /> 23 CCR 2715 Designated O erator: a Statement from UST owner; (c-c)Monthly inspection; Employee training <br /> 24 CCR 2638 a) Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test (MI) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 4 Annual line tightness test (Mi) <br /> 28 CCR 2661 Repair for tank/piping has had tightness test M2 <br /> 29 CCR 2643 e) Biennial tightness test of gravity piping(pre-January 1, 1984) <br /> 30 CCR 2643 d Triennial line test for conventional suction piping(pre-January1, 1984 Ml <br /> 31 HSC 25292.5 Double walls stem located within 1000'ofpublic well-ELD <br /> 32 CCR 2661 Permit to repair UST s stem <br /> 33 HSC 25286 a Hermit to alter monitoring system <br /> 34 HSC 25298 Permit to temporarily close UST system <br /> 35 HSC 25298 c 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: UIC <br /> EHD INSPECTOR: PHONE: <br /> i 16t-2443- Septic system: <br /> w �- -t 1 J V ❑Serves 220 people/day <br /> RECEIVED Y. TITLE: ❑Receives other than sanitary waste <br /> ,dam/ Other disposal methods: <br /> ❑Dry wells/French Drains <br /> EHD 23-02 <br /> 1/3/07 <br />