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r <br /> Ii <br /> t 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.sigov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> FaciFity;addess: UST# $. <br /> ( dl' 1 r Product g7 7 / <br /> Facility Contact: Title: J Phone: A <br /> nitoring Panel: Piping system. Overfill prevention: <br /> -TI-5 " I>Lsurized ❑Suction ❑Gravit echanical ❑Audible/visual <br /> Ens ection type: Violations: <br /> Routine "Mmonitoring Certification ❑Installation ❑Other: ❑M I-RDetect ❑M2-RPrev -3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=California Code of Regulations V R <br /> V=Violation;RV=Re eat Violation <br /> # Code Section `, <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test performed <br /> 3 1 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 y( <br /> 5 CCR 2632 b Monitoring Program(Monitoring&Response Plan is current and approved by the local agency. <br /> k <br /> 6 CCR 2712 i) Monitoring 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 CCR 2632(c)(2) UST monitoring system is present (M1) <br /> 1 1 CCR 2630 d UST system monitoring equipment is properly located to detect a leak M1) <br /> 12 HSC 25291 b) UST s stem monitoring equipment 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 Line leak detector(s) are installed (M 1) <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 Ml) <br /> 23 CCR 2715 Designate O erato a Statement from UST owne (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 (M1) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636(f)(4) Annual line tightness test M1) <br /> 28 CCR 2661 Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 a Biennial tightness test of gravity pipingre-Janus 1, 1984 <br /> 30 CCR 2643 d) Triennial line test for conventional suction piping( re-Janus I, 1984) M1) <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 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 /> 38 Other: <br /> EHD INS R: PHONE: UIC <br /> '7��/ Sematic system: <br /> (J C/ b Serves>_20 people/day <br /> RECEIV BY: I I h1.1:: —Receives other than sanitary waste <br /> \ , Other disposal methods: <br /> Dry wells/French mains <br /> EHD 23-02-002 REV 05/07 <br />