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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.s*gov.org/ehd UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT Facility name: Designated Operator: Inspection Date: Facility dress: 1 1 d 1 UST # . 'Product 71, Facility ontact: Title: Phone: Mnitoring Panel: TL52 5b Piping system: Pressurized ❑ Suction ❑ Gravity Overfill prevention: echanical ❑ Audible/visual Inspection type: Violations: outine Monitoring Certification ❑ Installation ❑ Other:-KM1-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 /10 706 3• CCR 2711 b & c Current Unified Program Consolidated Forms on file with EHD(Facility and tank form 4• HSC 25292.2 Certification of financial responsibility and CFO letter b 01 5• CCR 2632 b Monitoring Program(Monitoring & Response Plan is current and aDDroved by the local agency. 6• CCR 2712 i Monitoring Ian is onsite. 7 CCR 2712 b Maintenance & monitoring records(Mill 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) All releases in secondary pipingflow to a collection sum 17 HSC 25291 Line leak detector(s) are installed M1 18 CCR 2635 (b)(1) Spill container (MZ) 19 CCR 2635 (b)(2) Overfill prevention system M2 20 CCR 2636 (a) Conventional suction piping shall have continuous monitoring & 20 containment 21 HSC 25291 (e) Water in 20 containment analyzed & properly disposed of 22• CCR 2650 Record in /re orti ng of unauthorized releases M1 23• CCR 2715 Designated Operator: (a)'Statement from UST owner; a Monthly inspection: Otmployee training 24 CCR 2638 a Annual monitoring certification 3 0 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 e Biennial tightness test of gravity piping(pre-January 1, 1984 30 CCR 2643 d Triennial line test for conventional suction piping (pre -January 1, 1984) (M1) 31 HSC 25292.5 Double walls stem located within 1000' of public 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 37 HSC 25298 a Illegal abandonment of UST system 38 Other: WE7 TO /,a), PH ��UIC Septic system: ! Serves >_20 people/day Receives other than sanitary waste Other disposal methods: Dry wells/French Drains REderVfD BY: j bG TITLE: EHD 23-02-002 REV 8/08