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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMEN <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 STORArF TAAIK 11 ICTI DDn1--O ARA <br />Facility name <br />114011•"CVIIVN Ktl-(JRI <br />Designated Operator: Inspection <br />f I r <br />Date: f: <br />Facility address: <br />UST # <br />. <br />!� <br />.� �7 Jltirr-Gs�.lcr-e9 <br />Facility Contact: <br />I'iVe�' <br />Title: Phone: r <br />'Product <br />prevention: <br />Monitoring Panel: <br />Piping system: <br />Inspection <br />i .�• " , <br />type: <br />❑ Pressurized ❑ Suction ❑ Gravity <br />LOverfi" <br />Mechanical ❑ Audible/visual <br />❑ Routine ❑ Monitoring Certification ❑ Installation ❑ Other: <br />olations: <br />M1-RDetect ❑ M2-RPrev 11 M-3 Both <br /># <br />Code Section <br />VIOLATION(S) HSC=California Health & Safety Code; CCR=California Code of Regulations V R <br />V=Violation; RV=Re eat Violation V <br />1 <br />HSC 25284 <br />Permit tooperate <br />2 <br />CCR 2637 <br />SecondaEy containment test performed <br />3 <br />CCR 2711 b & <br />c Current Unified Program Consolidated Forms on file with EHD(Facility and tank form <br />4 <br />HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />5 <br />CCR 2632 b <br />Monitoring Program(Monitoring & Response Plan is current and approved by the local agency. <br />6 <br />CCR 2712 i <br />Monitoring Ian is onsite. <br />7 <br />CCR 2712 b <br />Maintenance & monitoring records <br />8 <br />CCR 2643 d <br />(M1) <br />Daily monitoring of suction piping (pre-Janual/, 1, 1984 <br />9 <br />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 />11 <br />CCR 2630 d <br />(M1) <br />UST system monitoring equipment isproperly located to detect a leak M1) <br />12 <br />HSC 25291 b <br />UST system monitoring equipment is operational <br />13 <br />CCR 2636 (f)(1 <br />(M1) <br />Continuous monitorings stem for underground piping & UDC is present (M1) <br />14 <br />CCR 2631 a <br />Primary containment is product tight <br />15 <br />HSC 25291 (a)(2) <br />Secondary containment for UST is tight <br />16 <br />CCR 2636 (c)(1) <br />All releases in secondary piping flow to a collection sum <br />17 <br />HSC 25291 f <br />Line leak detector(s) are installed <br />18 <br />CCR 2635 (b)(1) <br />(M1) <br />Spill container <br />19 <br />CCR 2635 (b)(2) <br />(M2) <br />Overfill prevention system <br />20 <br />CCR 2636 (a) <br />(M2) <br />Conventional suction i in shall have continuous monitoring& 20 containment <br />21 <br />HSC 25291 (e) <br />Water in 21 containment analyzed & proper) disposed of <br />22 <br />CCR 2650 <br />Recording/reporting of unauthorized releases (M1) <br />23 <br />CCR 2715 <br />Designated Operator: a Statement from UST owner; (c -e) Monthly inspection; 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 />26 <br />HSC 25284.2 <br />(M1 <br />Annuals ill containment testing <br />27 <br />CCR 2636 (f)(4) <br />Annual line tightness test (M1 <br />28 <br />CCR 2661 f <br />Repair for tank/piping has had tightness test <br />29 <br />CCR 2643 a <br />(M2) <br />Biennial tightness test of gravitypiping (pre-January1, 1984 <br />30 <br />CCR 2643 d <br />Triennial line test for conventional suction piping (pre -January 1, 1984) (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 />Permit 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 <br />Disabling leak detection devices <br />a 9 f 2 <br />37 <br />HSC 25298 a <br />Illegal abandonment of UST s stem <br />38 <br />1 Other: <br />EHD INSPECTOR: <br />—,�-. <br />PHONE: <br />UIC <br />,. q ��,�. ;•.�,.-,�_.._.. <br />_. . <br />Septic system <br />LI Serves >!20 people/day <br />RECEIVED BY: <br />TITLE: <br />C Receives other than sanitary waste <br />_Other disposal methods <br />I I Dry wells/French Drains <br />EHD 23-02-002 REV 8108 <br />