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SAN J0AQjJIN COI.PNTy <br /> ENVIRONMENTAL HEALI�H DEPARTMENT <br /> 304 East Weber Avenue,3`d <br /> Floor;Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sipov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated operator: Inspection Date: <br /> U V C 5" <br /> Facility address: UST# <br /> -7 <br /> - Product <br /> Facility Contact: Title: Phone: 4- <br /> Monitoring Panel: — Piping system: Overfill prevention: <br /> Empressurized E)Suction El Gravity "echanical El Audible/visual <br /> Inspection type: Violations: <br /> EYRoutine 2Monitoring Certification L1 Installation 11 Other: 0 M I-RDetect 11 M2-RPrev -3 Both <br /> VIOLATION(S) HSC=Califomia Health&Safety Code;CCR=Califomia Code of Regulations V R <br /> # Code Section V=Violation;RV=Repeat Violation V <br /> HSC 25-284 Permit tooperate <br /> CCR 2637 Secondary containment test performed <br /> -CCR 2711 (b)&(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 /> T—–CCR 2712(i) Monitoring&response plan is onsite <br /> 7 CCR 2712(b) Maintenance&monitoring records (Mi) <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 (Mi) <br /> 11 –CCR 2630(d) UST system monitoring equipment is properly located to detect a leak (MI) <br /> 12 HSC 25291 (b) UST system monitoring equipment isoperational (M2) <br /> –13 CCR 2636(f)(1) Continuous monitoring system for underground piping&UDC is present (MI) <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 piping flow to a collection sump <br /> 17 HSC 25291 (f) Line leak detector s)are installed (MI) <br /> T-8 . 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&2'containment <br /> -21—–HSC 25291 (e) Water in 2'containment analyzed&properly disposed of <br /> -22—–CCR 2650 Recordin reporfing of unauthorized releases (MI) <br /> 23—–CCR 2715 Designated Operator:(a)Statement from UST owner; (c-e)Monthly inspection; Employee training <br /> -'2-4 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(f)(4) Annual line fightness test (MI) <br /> -2-8 –CCR 2661 (f) Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643(e) Biennial tightness test of gravity piping(pre-January 1, 1984) <br /> -To-–CCR 2643(d) Triennial line test for conventional suction piping(pre-January 1, 1984) (Mi) <br /> TI HSC 25292.5 Double wall system located within 1000'of public well-ELD <br /> 3-2--–CCR 2661 Pen-nit to repair UST system <br /> 33 –HSC 25286(a) Pen-nit 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 /> 36HSC25299(a)(9) Disabling leak detection devices <br /> 37 HSC 25298(a) Illegal abandonment of UST system <br /> –38— Other: <br /> EHD INSPECTOR: PHONE: UIC <br /> C-i Septic system: <br /> 2 Serves�t20 people/day <br /> RECEIVED BY: TITLE: El Receives other than sanitary waste <br /> J Other disposal methods- <br /> DrY wells/French Drains <br /> ---------- <br /> FHD 23-02-002 <br />