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DATE t D� <br /> Pt*IC HEALTH SERVICES SAN JOAO& COUNTY PR# <br /> ENVIRONMENTAL HEALTH DIVIVIDN PAGE VV a <br /> 304 E.Weber Ave.,Third Floor, Stockton, CA 95202 <br /> (209) 468-3420 <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility Name Ny "\%ZA LC Facility Address t' uJ�iSt� <br /> Facilty ContacM0 N0V \.-P.— Title cx")% a Phone <br /> UST# 1 Product_ UST#a Product �� UST#_Product UST#_Product <br /> Overfill Prevention: AudibleNisuall. ec anical Monitoring Panel: \uCDV T%\2p\ <br /> Piping System: Gravity 4�ressur cion Violations: ino Major <br /> Automatic Pump Shut Do tisfies CR 2 Ye o Dispenser Pan: e§ No <br /> INSPECTION TYPE: outin M nitorin ion Comp t Install Removal Repair/Upgrade <br /> COMPANY NAME: S\�,, W . TECHNICIAN NAME: W\kA— L NE: 3)i <br /> VIOLATION(S) <br /> The above facility is not in compliance with the following section(s) of Health & Safety Code (HSC) and/or <br /> California Code of Regtilations (CCR): <br /> 1 HSC 25284 Permit to operate 19CCR 2712 (i) Monitoring &response plan <br /> 2 CCR 2637 Secondary cont testing (6 is on site <br /> month/36 month) 20 CCR 2712 (b) Maintenance &monitoring <br /> 3CCR 2711(b) &(c) Current State Forms A& B / records <br /> 4�HSC 25292.2 Certification of financial 21 J CCR 2636 (f)(4) Annual line tightness test <br /> responsibility and letter from 22CCR 2630 (d) Annual line leak detector test <br /> chief financial officer 23 CCR 2630 (d) Annual monitoring <br /> 5 CCR 2630 (d) Continuous monitoring certification <br /> system for UST system 24CCR 2643 (d) Daily monitoring of suction <br /> 6 CCR 2636 (c)(1) All releases in secondary piping that is not <br /> piping flow to a collection continuously monitored <br /> sump 25 CCR 2643 (d) Triennial tightness test of <br /> 7 HSC 25291 (e) Water in secondary(2°)cont suction piping that is not <br /> 8 HSC 25291 (f) Automatic line leak continuously monitored <br /> detector(s) 26 CCR 2643 (e) Biennial tightness test of <br /> 9 CCR 2636(f)(1) Continuous monitoring gravity piping that is not <br /> system for underground continuously monitored <br /> piping 27 CCR 2662 Upgrade requirements for <br /> 10CCR 2632 (c)(2) Continuous monitoring UST system <br /> system for UST 28 COR 2661 Permit to repair UST system <br /> 11HSC 25291(a)(2) Secondary containment for 29HSC 25286 (a) Permit to alter monitoring <br /> UST is tight system <br /> 12 CCR 2636 (f)(1) Continuous monitoring 30HSC 25298 (a) Illegal abandonment of UST <br /> system for dispenser system system <br /> 13CCR 2635 (b)(1) Spill container 31HSC 25298 (b) Permit to temporarily close <br /> 14CCR 2635 (b)(2) Overfill prevention system UST system <br /> 15CCR 2631 (a) Primary containment is 32 HSC 25298 (c) Permit to close UST system <br /> product-tight 33 HSC 25291 (e) Water in 20 cont analyzed <br /> 16HSC 25292.1 UST system is operated to and properly disposed of <br /> prevent unauthorized release 34CCR 2640(e) Single wall component within <br /> 17 CCR 2650 Recording/reporting 1 000'of Public Well, no ELD <br /> unauthorized release 36CCR 2635(a)(2)(A) Cathodic protection testing <br /> 18 CCR 2632 (d) Monitoring &response plan 35 Violation(s) not listed above <br /> EHD INSPECT PHONE: <br /> RECEIVED BY: ITLE: 1 PHONE: <br /> UNITIII/UST/INSP(rev 12119/01) <br />