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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTHDEPARTMEI\aastj <br /> 304 East Weber Avenue,3"Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sj ov or /g ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br /> Facilityname: <br /> Designated Operator: Inspection Date: <br /> 6sL �AS VLIOY ��pt I'VA <br /> Facility address: fi Yv' 1. <br /> UST# <br /> Product <br /> Facility Contact:VfA <br /> Title: Phone: <br /> )lonitoring Ppnel Piping system: Overfill prevention: <br /> Pressurized ❑Suction 11 Gravity ld,Mechanical ❑Audible/visual <br /> Inspection type: - Violations: <br /> D Routine Monitoring Certification ❑Installation ❑Other: D Ml-RDetect D M2-RPrev 11M-3 Both <br /> # Code Section VIOLATIONS) HSC=Califomia Health&Safety Code;CCR=California Code of Regulations V R <br /> V=Violation;RV=Re eat Violation V <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test performed <br /> 3 CCR 2711 6 & c Current Unified Pro ram Consolidated Forms 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 21an is current and filed with the local agency <br /> 6 CCR 2712 i Monitoring&response plan is onsite + <br /> 7 CCR 2712 6 Maintenance&monitoring records Ml <br /> 8 CCR 2643 d Daily monitoring of suction piping(pre-January, 1, 1984) <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present M1 <br /> 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak M1 i <br /> 12 HSC 25291 6 UST system monitoring equipment isoperational M2) ' <br /> 13 CCR 2636(f)(I) Continuous monitoring system for underground piping&UDC isresent . - Ml <br /> 14 CCR 2631 a " Primar containment is roducf tight — - - <br /> 15 HSC 25291 (a)(2) Secondary containment for UST is tight <br /> 16 CCR 2636(c)(1) All releases in secondary piping flow to'a collection sumpt <br /> 17 HSC 25291 Line leak detector(s)are installed M7 <br /> 18 1 CCR 2635(b)(1) Spill container (M2) V <br /> 19 CCR 2635(b)(2) Overfill prevention system M2 <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&20 containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&properly disposed of <br /> -22 CCR 2650 Recording/reporting of unauthorized releases M1 <br /> 23 CCR 2715 Designated Operator: (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 (Ml) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 (4) Annual line tightness test Ml <br /> 28 CCR 2661 (f) Repair for tank/piping has had tightness test (M2 <br /> 29 CCR 2643(c) Biennial ti ghtness test of gravity piping re-Janus 1, 1984 <br /> 30 CCR 2643(d) Triennial line test for conventional suction piping(pre-Jamary1, 1984 (Ml <br /> 31 HSC 25292.5 Double wall system located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to re air UST system <br /> 33 HSC 25286(a) Permit to alter monitoring system <br /> 34 HSC 25298(b) Permit to temporarily close UST system <br /> 35 HSC 25298 c Permit to close UST system <br /> 36 1 HSC 25299(aX9) Disabling leak detection devices _, <br /> 37 HSC 25298 a Ille al abandonment of UST system <br /> 38 Other: <br /> EHD INSPECTOR: PHONE: UIC <br /> Septic system: <br /> - . � ❑Serves>20 people/day <br /> RECEIVED BY: TITLE: 1!Receives other than sanitary waste <br /> Other disposal methods: <br /> 11 Dry wells/French Drains <br /> FRT)23-02-002 <br />