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SAN JOAQUIN COUNTY <br /> 4VIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3`d Floor, Stockton,CA 95202-2708 <br /> • r <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sj og v.orgehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> F.._aty address: UST# <br /> Product <br /> Facility Contact: Title: Phone: , <br /> Monitoring Panel: Piping system: Overfill prevention: <br /> 11 Pressurized ❑Suction ❑Gravity ❑Mechanical ❑Audible/visual <br /> Inspection type: Violations: <br /> Routine [IMonitoring Certification 11Installation ElOther: Q Ml-RDetect ❑M2-RPrev ❑M-3 Both <br /> # Code Section <br /> VIOLATION(S) HSC=Califomia Health&Safety Code;CCR=Califomia Code of Regulations V R V=Violation;RV=Re eat Violation `, <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test performed <br /> 3 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 <br /> 5 CCR 2632 c 2 D) Monitoring&response plan is current and filed with the local agency <br /> 6 CCR 2712(i) Monitoring&response plan 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 Ml <br /> 1 1 CCR 2630(d) UST system monitoring equipment is properly located to detect a leak Ml <br /> 12 HSC 25291 b UST system monitoring equipment isoperational M2) <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping&UDC is present M1 <br /> 14 CR 2631 a) Primary containment is product tight <br /> 15 HSC 25291 (a)(2)--,j Secondary containment for UST is tight <br /> lti CCR 2636(c)(1) All releases in secondary piping flow to a collection sum <br /> HSC 25291 ( Line leak detector(s)are installed Ml <br /> 118 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 Designated Operator: (a)Statement from UST owner; (c-e)Monthly inspection;(f)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 testingb` <br /> 27 CCR 2636 4 Annual line tightness test M1 <br /> 28 CCR 2661 (f) Repair for tank/piping has had tightness test (M2 <br /> 29 CCR 2643 e Biennial tightness test of gravity piping(pre-January 1, 1984) <br /> 30 1 CCR 2643(d) Triennial line test for conventional suction piping(pre-January1, 1984) (MI) <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 ) Permit to temporarily close UST system <br /> 35 HSC 25298(c) Permit to close UST system <br /> 36 1 HSC 25299(a)(9) Disabling leak detection devices <br /> 37 HSC 25298 a Illegal abandonment of UST system <br /> 38 1 Other: <br /> EHD INSPECTOR: -- + PHONE: UIC <br /> Septic system: <br /> Serves>_20 people/day <br /> RECEIVED BY: TITLE: Receives other than sanitary waste <br /> Other disposal methods: <br /> Dry wells/French Drains <br /> FFD 23-02-002 <br />