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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.st oQ v.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility ame: � D ignatedOperator: Inspection Date: <br /> 04 CA? <br /> Faci' address: L/n^ ST#� 7.�/►'' �jtSs <br /> Product 0 / �b / / <br /> Facili Contact: Title: Phone: <br /> Mo 'to 'ngaq�; Piping system: Overfill prevention: <br /> ��J1✓) Pressurized ❑Suction ❑Gravity ❑Mechanical udible/visual <br /> spection type: Violations: <br /> Routine onitoring Certification ❑Installation ❑Other: ❑Ml-RDetect 2-RPrev ❑M-3 Both <br /> VIOLATIONS) HSC=California Health&Safety Code;CCR=Califomia Code Regulations V R <br /> # Code ection <br /> V=Violation; RV=Repeat Violation V <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test performed <br /> 3 CCR 2711 b)& c Current Unified Program Consolidated Forms on file with EHD(Facility and tank form) <br /> 4 1 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632 b Monitoring Program(Monitoring&Response Plan)is current and approved by the local agency. <br /> 6 CCR 2712 i) Monitorin Ian is onsite. <br /> 7 CCR 2712 b Maintenance&monitoring records M1 <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 1 CCR 2632(c)(2) UST monitoring system is present (M1) <br /> I l CCR 2630 d) UST system monitoring equipment is properly located to detect a leak M1 <br /> 12 HSC 25291 b) UST system monitoring equip ment isoperational (M2) <br /> 13 CCR 2636(t)(1) Continuous monitoring system for underground piping&UDC is present M1 <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 t Line leak detector(s)are installed M1 <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&2°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-e)Monthly inspection, t)Employee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638 a) Annual line leak detector test (M 1) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636(f)(4) Annual line tightness test M1) <br /> 28 1 CCR 2661 t 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 /> 30 CCR 2643 d) Triennial line test for conventional suction piping(pre-January I, 1984) (MI) <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 1 HSC 25298 b) 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 /> 3 Other: <br /> E IN CH UIC <br /> �-7b� Se tic system: <br /> R5 <br /> / -Serves>20 people/day <br /> ECEIVED Y: TIT E: -Receives other than sanitary waste <br /> Other disposal methods: <br /> -Dry wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />