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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT v <br /> 304 East Weber Avenue,3rd Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax. (209)468-3433 Web:www s' ovJg ore/ehd <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Designated Operator: Inspection Date: <br /> Facility name: DhA <br /> Facility address: UST# . 3 <br /> t4 Product <br /> Fati ity Contact: Title: Phone: <br /> MoOnitori g P el Piping system: Overfill prevention: <br /> Pressurized ❑Suction ❑Gravity Mechanical ❑Audible/visual <br /> Inspection type: Violations: <br /> Routine Monitoring Certification ❑Installation ❑Other: ❑Ml-RDetect ❑M2-RPrcv M-3 Both <br /> VIOLATION(S) HSC=Califomia Health&Safety Code;CCR=Califomia Code of Regulations V R <br /> # Code Section V=Violation;RV=Re eat Violation V <br /> 1 I HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test performed <br /> 3 CCR 2711 6 & c Current Unified Program 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 plan is current and filed with the local agency <br /> 6 CCR 2712 i Monitoring&response plan is onsite <br /> 7 CCR 2712 b Maintenance&monitoring records MI <br /> 8 CCR 2643 d Daily itoring of suction pipinS(pre-January, 1, 1984 <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 1 CCR 2632(c)(2) UST monitoring system is present Ml <br /> 11 1 CCR 2630 d UST system monitoring equipment is properly located to detect a leak Ml <br /> 12 1 HSC 25291 UST system monitoring equipment isoperational M2 <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping&UDC is present Ml <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 detectors are installed MI <br /> 18 CCR 2635(b)(1) Spill container M2 <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 Recordingireporting of unauthorized releases Ml <br /> 23 CCR 2715 Designated Operator: (a)Statement from UST owner; (c-e)Monthly inspection; Em to ee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638 a Annual line leak detector test (M1) <br /> 26 HSC 25284.2 Annuals ill containment testi n <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 a Biennial tightness test of gravity pipingre-Jana 1, 1984 <br /> 30 CCR 2643 d Triennial line test for conventional suction piping(pre-Jamiary1, 1984 (Ml <br /> 31 1 HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to repair UST system <br /> 33 HSC 25286 a Permit to alter monitoring system <br /> 34 HSC 25298 ) Permit totemporarrily 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: <br /> EHD INSPECTOR: PHONE: 2 UIC <br /> Septic system: <br /> Serves 220 people/day <br /> RECEIVED BY- TITLE: ❑Receives other than sanitary waste <br /> d _ <br /> 1, O /r Other disposal methods: <br /> (0 ❑Dry wells/French Drains <br /> F.HD 23-02-002 <br />