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• SAN JOAQUIN COUNTY • ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, California 95202-3029 Telephone: (209)468-3420 Fax. (209)468-3433 Web:www.s"gov.org/ehd/tinitiii.htmi UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT Facility Name: G'r�' �� Facility 1 LOO I '_5� Inspection 01 / Address: '�j li..�' r Date: I Facility Title: r�' (y�� Contact: ' C..��,c.. Phone: TvZ� Inspection Type. Routine `s Monitoring System Certification Installation ❑Complaint—ID#: ❑Other: (Authority HSC 25289 Consent forlyspedion ampling hotos Granted by: A �'��,{/Q, Title: Monitoring Piping Overfill Panel: U / (rs�3 S-Q System: Pressurized C Suction\Gravity Mechanical r Audible/visual Prevention: UST - - - - ------ -- Product._. __u O _df rO'Cri � __.___._._ _ -------------- -------------- -------------- _._.___ ---- _._._._._._ _ Designated ICC Exp. Operator: 2 Date: S 3l>--fib Violations: r Mt-Release Detection ,M2-Release Prevention F1103—Both On Site Service ICC Exp. Manufacturer's Technician: Date: // S Training: 3�/ V r.�--I-.. 9 1/ woLArIONS L O # Cl C2 M Code Section HSC=California Health and Sai Code;CCR=California Code of Regulations C1 =Class 1 violation;C2=Class 2 violation;M=Minor violation File Review 101 HSC 25284 No permit to operate 102 HSC 25404.5 Annual operating fees not paid 103 HSC 25284(a)(3) No written agreement between the person that the operating permit was issued to and the tank operator to monitor the tank s stem 104 HSC 25292.2 Current financial responsibility documents not on file with the Environmental Health Department(EHD) 105 CCR 2711 Current Unifed Program Consolidated Forms not on file with the EHD(Facility and tank form) 106 CCR 2632(b) Monitoring Program(Monitoring&Response Plans)is not current or approved by the EHD 107 CCR 2632(d)(1)(C) Plot plan/site map not submitted or fails to completely show where monitoring is performed 108 CCR 2637 Secondary containment:(a)test not performed;(e)test report not submitted within 30 days;(f)test notification not provided to the EHD at least 48 hours prior to conductin the test Monitoring equipment certification:(a)not performed annually;(d)test report not submitted within 30 days; 109 CCR 2638 (e)test notification not provided to the EHD at least 48 hours prior to conducting an installation,repair, replacement,calibration,or certification 110 HSC 25291(f) Annual line leak detector test not performed 111 HSC 25284.2 Annual spill containment testing not performed (Mt) 112 CCR 2636(f)(4) Annual line tightness test not performed if positive shutdown or fail safe not present 113 CCR 2715(a) Failed to inform the EHD of a change of designated operator within 30 days (M11 114 CCR 2715(b) Designated operator does not possess a current ICC CA UST System Operator certification 115 CCR 2660(k) Repair for tank or piping not tested for tightness after completion of the repair pursuant to (M2) ermit conditions 116 HSC 25292.5 Enhanced leak detection(ELD)testing not performed on a system located within 1000'of public well,or failures not repaired and retested 117 CCR 2661 Permit to repair UST system not obtained 118 HSC 25286(a) Operational permit not amended when UST storage and/or monitoring system changed 119 HSC 25298(b) Permit to temporarily close UST system not obtained 120 HSC 25298(c) Pennit to close UST system not obtained " On Site Records Maintenance&monitoring records not maintained 3 years,cathodic protection records for 6%yearswritten performance claims pertaining to release detection systems for 5 years,or records of repairs,linings,and 201 CCR 2712(b) upgrades for the life of the tank. Monitoring records include:(1)date and time of all monitoring or sampling; (2)monitoring equipment calibration and maintenance records;(3)results of any visual observations;(4) results of sample analysis performed a lab or in the field;(5)logs of all readings of gauges or other monitoring e ui ment, round water elevations,or other test results; 6 results of invento readings and reconciliations 202 CCR 2712(i) Monitoring plan,response plan,and/or operating permit and all conditions not onsite Unauthorized release that:(c)did not escape secondary containment and cleaned up within eight hours (M1) 203 CCR 2650 was not recorded;(e)escaped secondary containment,not cleaned ul after eight hours,or a sudden loss of product was not reported to the EHD within 24 hours Inspector: Receivetl Title: EHD 23-02 v 9l l 1 Page 1 UST INSPECTION REPORT