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SAN JOAQUIN COUNTY _NVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, California 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd UNDERGROUND STORAGE TANK (UST) PROGRAMA INSPECTION REPORT Facility.name: f Designated Operator: Inspection Date: Facility address: UST # Product .' Facility Contact: Title: Phone: Monitoring Panel•.. °•� y?"?✓ Piping system: '❑ Pressurized ❑ Suction ❑ Gravity Overfill prevention: ❑ Mechanical ❑ Audible/visual Inspection type: ❑ Routine `0 Monitoring Certification ❑ Installation ❑ Other: Violations: ❑ M1-RDetect ❑ M2-RPrev ❑ M-3 Both # Code Section VIOLATION(S) HSC=California Health & Safety Code; CCR=California Code of Regulations V R V=Violation; RV=Re eat Violation V 1 HSC 25284 Permit tooperate 2 CCR 2637 Secondary containment test performed 3 CCR 2711 b & c Current Unified Program Consolidated Forms on file with EHD(Facility and tank form v' 4 HSC 25292.2 Certification of financial responsibility and CFO letter ' 5 CCR 2632 b Monitoring Pro ram(Monitoring & Response Plan is current and approved by the local agency. 6 CCR 2712 i Monitorinq Plan is onsite. 7 CCR 2712 b Maintenance & monitoring records M1 8 CCR 2643 d Daily monitoring of suction piping (pre -January, 1, 1984 9 HSC 25292.1 UST system isoperated to prevent unauthorized release 10 CCR 2632 (c)(2) UST monitoring system is present M1) 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak M1 12 HSC 25291 b UST system monitoring equipment isoperational (M1) 13 CCR 2636 1 Continuous, Monitoring system for underground piping & UDC is present M1 14 CCR 2631 a , " Primary containment is product tight 15 HSC 25291 (a)(2) Secondary containment for UST is tight 16 CCR 2636 (c)(1) 4JI releases -in e�cdary pipingflow to a collection sum 17 HSC 25291 ( ' Line' leak'detect&'r(s)'are installed �' , i ! �� ' l M1 18 CCR 2635 b 1 .� Spill container (M2) 19 CCR 2635 (b)(2) Overfill prevention system M2 20 CCR 2636 (a) Conventional suction piping shall have continuous monitoring & 2° containment 21 HSC 25291 (e) Water in 21 containment analyzed & properly disposed of 22 1 CCR 2650 Recording/reporting of unauthorized releases M1 23 1 CCR 2715 Designated Operator: a Statement from UST owner; (c -e) Monthly inspection; Employee training 24 CCR 2638 a Annual monitoring certification 25 CCR 2638 a Annual line leak detector test M1 26 HSC 25284.2 Annuals ill containment testing 27 CCR 2636 4 Annual line tightness test M1) 28 CCR 2661 Repair for tank/piping-has had tightness test (M2) 29 CCR 2643 lel Biennial tiahtness test of aravity piping (pre -January 1, 1984) 30 CCR 2643 d Triennial line test for conventional suctio ,pipin (re -Janus 1, 1984) (M1) 31 HSC 25292.5 Double walls stem located within 1000' oPPMlic well-ELD 32 CCR 2661 Permit to repair UST system 33 HSC 25286 a Permit to alter monitoring system 34 HSC 25298 b Permit to temporarily close UST system 35 HSC 25298 c Permit to close UST system 36 HSC 25299 (a)(9 2 Disabling leak detection devices ( n, '( f� s Z 37 HSC 25298 a r ` llle al abandonment of UST system 38 Other. EHD INSPECTOR: E J i `, PHONE: _.' `-1., UIC Serves >_20 people/day ❑ Receives other than sanitary waste Other disposal methods: ❑ Dry wells/French Drains RECEIVED BY: i TITLE: EHD 23-02-002 REV 8/08