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DATE <br />PR# <br />PAGE I <br />PUBLIC HEALTH SERVICES SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DIVISION <br />304 E. )Veber Ave., Third Floor, Stockton, CA 95202 <br />(209) 468-3420 <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility Name &UAD Facility Address <br />Facilty Contact U ONk A4-\ SOe&b Title Phone # N (- kc -11 <br />UST# Product UST# Z Product UST#Product UST# Product <br />OVERFILL PREVENTION: ❑ Audible/Visual Mechanical Monitoring Panel: <br />PIPING SYSTEM: []Gravity 56f ressure ❑ Suction fly -JC � "^- Violations: *linor ❑ Major <br />AUTOMATIC PUMP SHUWOWN SATISFIES CCR 2636 (q): 5(Yes ❑ No <br />INSPECTION TYPE:leoutine ❑Monitoring Certification ❑Coi'nplaint ❑Install ❑Removal ❑Repair/Upgrade <br />COMPANY NAME: TECHNICIAN NAME: to, WONE: (S IU <br />VIOLATION(S) <br />The above facility is not in compliance with the following section(s) of Health & Safety Code (HSC) and/or <br />California Code of Regulations (CCR): <br />1 <br />HSC 25284 <br />Permit to operate <br />2 <br />CCR 2637 <br />Secondary Cont. Testing <br />3CCR 2711(b) & (c) Current State Forms A & B <br />4 <br />HSC 25292.2 <br />Certification of financial <br />CCR 2712 (i) <br />Monitoring & response plan <br />responsibility and letter from <br />is on site <br />chief financial officer <br />5 <br />CCR 2630 (d) <br />Continuous monitoring <br />records <br />system for UST system <br />6 <br />CCR 2636 (c)(1) <br />All releases in secondary <br />CCR 2630 (d) <br />Annual line leak detector test <br />piping flow to a collection <br />/ <br />Annual monitoring <br />sump <br />7 V <br />CCR 2636 (a) <br />Secondary containment for <br />CCR 2643 (d) <br />Daily monitoring of suction <br />piping is waterproof <br />8 <br />HSC 25291 (f) <br />Automatic line leak <br />continuously monitored <br />detector(s) <br />9 ZCCR <br />2636 (f)(1) <br />Continuous monitoring <br />system for underground <br />piping <br />10 <br />CCR 2632 (c)(2) <br />Continuous monitoring <br />system for UST <br />11 <br />HSC 25291(a)(2) <br />Secondary containment for <br />27 <br />CCR 2662 <br />UST is tight <br />12 <br />CCR 2636 (f)(1) <br />Continuous monitoring <br />28 <br />CCR 2661 <br />system for dispenser system <br />13 <br />CCR 2635 (b)(1) <br />Spill container <br />14 <br />CCR 2635 (b)(2) <br />Overfill prevention system <br />15 <br />CCR 2631 (a) <br />Primary containment is <br />product -tight <br />16 <br />HSC 25292.1 <br />UST system is operated to <br />prevent unauthorized release <br />17 <br />CCR 2650 <br />Recording/reporting <br />unauthorized release <br />18 <br />CCR 2632 (d) <br />Monitoring & response plan <br />19 <br />CCR 2712 (i) <br />Monitoring & response plan <br />is on site <br />20 <br />CCR 2712 (b) <br />Maintenance & monitoring <br />records <br />21 <br />CCR 2636 (f)(4) <br />Annual line tightness test <br />22 <br />CCR 2630 (d) <br />Annual line leak detector test <br />23 <br />CCR 2630 (d) <br />Annual monitoring <br />certification <br />24 <br />CCR 2643 (d) <br />Daily monitoring of suction <br />piping that is not <br />continuously monitored <br />25 <br />CCR 2643 (d) <br />Triennial tightness test of <br />suction piping that is not <br />continuously monitored <br />26 <br />CCR 2643 (e) <br />Biennial tightness test of <br />gravity piping that is not <br />continuously monitored <br />27 <br />CCR 2662 <br />Upgrade requirements for <br />UST system <br />28 <br />CCR 2661 <br />Permit to repair UST system <br />29 <br />HSC 25286 (a) <br />Permit to alter monitoring <br />system <br />30 <br />HSC 25298 (a) <br />Illegal abandonment of UST <br />system <br />31 <br />HSC 25298 (b) <br />Permit to temporarily close <br />UST system <br />32 <br />HSC 25298 (c) <br />Permit to close UST system <br />33 <br />Violation(s) not listed above <br />EHD INSPECTOR:��-, Z-\ <br />