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1 <br />OA- <br />2UCCR 2637 Secondary cont testing (6 <br />month/36 month) <br />3 V CCR 2711(b) & (c) Current State Forms A & B <br />4�HSC 25292.2 Certification of financial <br />responsibility and letter from <br />chief financial officer <br />5 CCR 2630 (d) Continuous monitoring system <br />for UST system <br />6 CCR 2636 (c)(1) All releases in secondary piping <br />flow to a collection sump <br />7 HSC 25291 (e) Water in secondary (21) cont <br />8 HSC 25291 (f) Automatic line leak detector(s) <br />9 CCR 2636 (f)(1) Continuous monitoring system <br />for underground piping <br />10 CCR 2632 (c)(2) Continuous monitoring system <br />for UST <br />11 HSC 25291(a)(2) Secondary containment for <br />UST is tight <br />12 CCR 2636 (f)(1) Continuous monitoring system <br />for dispenser system <br />13 CCR 2635 (b)(1) Spill container <br />14 CCR 2635 (b)(2) Overfill prevention system <br />15 CCR 2631 (a) Primary containment is product - <br />tight <br />16 HSC 25292.1 UST system is operated to <br />prevent unauthorized release <br />17 CCR 2650 Recording/reporting <br />unauthorized release <br />18 `/ CCR 2632 (d) Monitoring & response plan <br />19 CCR 2712 (i) Monitoring & response plan is <br />on site <br />DATE -Z%'®� <br />SAN JOAQUIN COUNTY PR# <br />a =u <br />*VIRONMENTAL HEALTH DEPART NT PAGE o <br />304 E. Weber Ave., Third Floor, Stockton, CA 95202 <br />(209) 468-3420 <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />v 6"'?d Wg� Gtib <br />Facility Name�Gonp L&, 0. 'ry�-' Facility Address <br />_6 <br />Contact S S7VAN` Title ASt4, "!ISW Phone # Y 'O? <br />UST# Product 'N UST# Product UST# Product UST# Product <br />Overfill Prevention: ❑ AudibleNisual ❑ Mechanical Monitoring Panel: <br />Piping System: Gravity ❑ Pressure ❑ Suction Violations: X Minor ❑ Major <br />Automatic Pume Shut Down Satisfies CCR 2636 : ❑ Yes ❑ No Dispenser Pan: ❑ Yes &No <br />INSPECTION TYPE: iWoutine )CMonitoring Certification ❑Complaint ❑Install ❑Removal ❑Repair/Upgrade <br />COMPANY NAME: NIC (10105 •:3 TECHNICIAN NAME: PHONE: 3 b5 -.10 <br />12 q6 - <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 />HSC 25284 Permit to operate 1 20 v CCR 2712 (b) Maintenance & monitorin <br />RECEIVED BY: <br />UNITIIUUSTANSP (rev 3/5/02) <br />9 <br />records <br />21 CCR 2636 (f)(4) Annual line tightness test <br />22CCR 2630 (d) Annual line leak detector test <br />23—V'CCR 2630 (d) Annual monitoring certification <br />24 CCR 2643 (d) Daily monitoring of suction <br />piping that is not continuously <br />monitored <br />25 CCR 2643 (d) Triennial tightness test of <br />suction piping that is not <br />continuously monitored <br />26 CCR 2643 (e) Biennial tightness test of gravity <br />piping that is not continuously <br />monitored <br />27 CCR 2662 Upgrade requirements for UST <br />system <br />28 CCR 2661 Permit to repair UST system <br />29 HSC 25286 (a) Permit to alter monitoring <br />system <br />30 HSC 25298 (a) Illegal abandonment of UST <br />system <br />31 HSC 25298 (b) Permit to temporarily close UST <br />system <br />32 HSC 25298 (c) Permit to close UST system <br />33 HSC 25291 (e) Water in 20 cont analyzed and <br />properly disposed of <br />34 CCR 2640 (e) Single wall component within <br />1000' of Public Well, no ELD <br />35 CCR 2635(a)(2)(A) Cathodic protection testing <br />36 H&SC 25299(a)(9) Disabling leak detect. devices <br />37 Violation(s) not listed above <br />