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UIN COUN <br /> IRONMENTAL HEALTH DEPARTMENT <br /> 4 East Weber Avenue,Yd Floor,Stockton,CA 95202-2708 r i <br /> LTeone:(209)468-3420 Fax:(209)468-3433 Web:www.s ov.or ehdUNDERSTORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Facility name: Designated One tor: <br /> Inspection Date: <br /> Facility address: UST# q p <br /> 2 y� t - Product '� 1 <br /> Facility Contact: '-� Title: Phone: <br /> s <br /> Monitorin Pa I: Pipi system: Overt evention: <br /> surized 0 Suction ❑Gravi echanical ❑Audiblelvisual <br /> Insp atype: Violations: <br /> utine 0 Monitorin Certification 0 Installation 0 Other: 0 MI-RDetect 0 M2-RPreV 0 M-3 Both <br /> VIOLATION(S) HSC=Califomia Health&Safety Code;CCR=Califamia Code of Regulations V R <br /> # Code Section V=Violation;RV=Re eat Violation V <br /> II HSC 25284 Permit to oggatc. T' <br /> 2 1 CCR 2637 Second c tainment test erform &- <br /> 3 CCR2711 6 & c Current Unified Program Conso i ated Formty and tank form <br /> 4 HSC 25292.2 Certification of£mancial res onsibi and CFO letter <br /> 5 CCR 2632 c 2 D Monitorin &res onse Ian K current d filed with the local a e <br /> 6 CCR 2712 i Monitorin &response Ian nsite - <br /> 7 CCR 2712 6 Maintenance&monitoring records Ml <br /> 8 CCR 2643 d Daily monitoring of suction piping(pre-januaty, 1, 1984 <br /> 9HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632 c 2 UST monitoring system is present Ml <br /> I 1 I CCR 2630 d UST system moni oring equipment is properly located to detect a leak Ml <br /> 12 1 HSC 25291 USTsysternmomtorin equipment isoperational M2 <br /> 13 CCR 2636 I 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 Recording/reporting of unauthorized releases Mt <br /> 23 CCR 2715 Designated Operator:(a)Statement from UST owner; (c-e)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 Annual spill containment testing <br /> 27 CCR 2636 4 Annual line tightness test M7 <br /> 28 CCR 2661 Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 a Biennial tightness test of gravity pipingre-Jams 1, 1984) <br /> 30 CCR 2643 d Triennial line test for conventional suction piping( re-Jana 1, 1984) (Ml) <br /> 31 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 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: <br /> EHD INSPECTOR: PHONE:P IC I <br /> /E: �,O Se [ic system: <br /> G 6 C Serves 220 d <br /> RECEIVED TITLE:D �A1`j, Receives other than sanitary waste <br /> 'IrOther disposal mcthdgds: <br /> Dry wells/French Drains <br /> EHD 23-02-002 <br />