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SAN JOAQUIN COUNTY <br />c�I\1VIRONM.ENTAL HEALTH DEPARTMENT <br />600 East Main St Tet, Stockton, California 95202-3029 <br />Telephone. (209) 468-3420 lax. (209) 468-3433 Weil: www.sjgov.org./ehd � <br />UW.10>� <br />NTDERGY wf:),ti ND `''FORAGE TANK PROGRAM INSPECTION ;REP <br />Facility name: ��_���•-�,...,... �_•..,..�,,.-.,....�,„�,,.,..•,...._� <br />Code Section <br />_ — <br />D ignated Operator: <br />VOW <br />�t nspectio ate: <br />1 <br />HSC 25284 <br />Permit tooperate <br />Facility address: <br />ROM,W I <br />T (n 1 <br />UST # <br />I., 'Prod <br />6 <br />/ <br />3 <br />CCR 2711 (b) & c <br />r <br />IConta t• Tltie: <br />Phone: <br />�5D <br />HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />or,ing Panel: P ing system: <br />5 <br />Overfill prevention: <br />Monitoring Program (Monitoring & Response Plan) is current and approved by the local agency. <br />Tit <br />Pressurized <br />❑ Suction ❑ Gravity <br />❑ Mechanical <br />Audible/visu_al <br />pection type: v <br />7 <br />Violations: <br />Maintenance & monitoring records <br />ZIn <br />Routine Yylonitoring Certification <br />❑ Installation ❑ Others <br />❑ Ml-RDetect 0 <br />M2-RPrev ❑ M-3 Both <br /># <br />Code Section <br />_ — <br />�r'IOL1JiT IONS} HSC=California Health & Safety Code; CCR=California Code of Regulatioas <br />V=Violation; RV=Repeat Violation <br />V I R <br />V <br />1 <br />HSC 25284 <br />Permit tooperate <br />2 <br />CCR 2637 <br />Secondary containment test perfopned <br />3 <br />CCR 2711 (b) & c <br />Current Unified Program Consolidated Forms on file with EFID (Facility and tank form <br />4 <br />HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />5 <br />CCR 2632 ) <br />Monitoring Program (Monitoring & Response Plan) is current and approved by the local agency. <br />6 <br />CCR 2712 i) <br />Monitoring plan is onsite. <br />7 <br />CCR 2712 b <br />Maintenance & monitoring records <br />M1 <br />8 <br />CCR 2643 d) <br />Daily monitoring of suction piping (pre -January, 1, 1984) <br />9 <br />1 HSC 25292.1 <br />UST system isoperated to prevent unauthorized release <br />10 <br />CCR 2632 (c)(2) <br />UST monitoring system, is present <br />(MI) <br />1 l <br />CCR 2630 (d) <br />UST system monitoring equipment is properly located to detect a leak <br />Ml <br />12 <br />HSC 25291 (b) <br />UST system monitoring ui pent isoperational <br />2) 11 <br />13 <br />CCR 2636 (0(l) <br />Continuous monitoring system for underground piping & UDC is present <br />Ml <br />14 <br />CCR 2631 a <br />Primary containment is product tight <br />IS <br />1 NSC 25291 (a)(2) <br />Secondary containment for UST is tight <br />16 <br />CCR 2636 (c)(1) <br />All releases in secondary pipingflow to a collection sum <br />17 <br />HSC 25291 <br />Line leak detectors are installed <br />(M1) <br />18 <br />CCR 2635 (b)(1) <br />Spill container <br />(M2) <br />19 <br />CCR 2635 (b)(2) <br />Overfill prevention s stem <br />(M2) <br />20 <br />CCR 2636 (a) <br />Conventional suction piping shall have continuous monitoring & 2° containment <br />21 <br />HSC 25291 (e) <br />Water in 2° containment analyzed & properly disposed of <br />22 <br />CCR 2650 <br />Recordin ortiny, of unauthorized releases <br />(MI) <br />23 <br />CCR 2715 <br />DesignatedOperator: (a) Statement from UST owner; (c -e) Monthly inspection; (f) Employee training <br />24 <br />CCR 2638 a <br />Annual monitoring certification <br />25 <br />CCR 2638 a) <br />Annual line leak detector test <br />(M 1) <br />26 <br />HSC 25284.2 <br />Annuals ill containment testing <br />27 <br />CCR 2636 (f)(4) <br />Annual line tightness test <br />(MI) <br />28 <br />CCR 2661 (f) <br />Repair for tank/piping has had ti htress test <br />(M2) <br />29 <br />1 CCR 2643 (e) <br />Biennial tightness test of gravity pipingre-Janus 1, 1984 <br />30 <br />1 CCR 2643 (d) <br />Triennial line test for conventional suction piping (pre -January 1, 1984) <br />(M1) <br />31 <br />HSC 25292.5 <br />Double walls stem located within 1000' of public well-ELD <br />32 <br />CCR 2661 <br />Permit to repair UST system <br />33 <br />HSC 25286 a) <br />Pen -nit to alter monitoring system <br />34 <br />HSC 25298 (b) <br />Permit to temporarily close UST system <br />35 <br />HSC 25298 (c) <br />Permit to close UST system <br />36 <br />HSC 25299 (a)(9) <br />Disabling leak detection devices <br />37 <br />HSC 25298 a) <br />Illegal abandonment of UST system <br />3 <br />Other: <br />E <br />INSPECTORa <br />// <br />RHONE: <br />UIC <br />l/ <br />/ r Septic system: <br />J 7 Serves 220 people/day <br />RECE V B — — - - TITLE: ❑ Receives other than sanitary waste <br />Other disposal methods: <br />f <br />7-1 Dry wells/French Drains <br />EHD 23-02-002 REV 05/07 <br />