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M SAN JOAQUIN COUNTY <br /> IONVIRONMENTAL HEALTH DEPARTMENT• <br /> 304 East Weber Avenue,3`d Floor, Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sj og v.or /,g ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> Facility address: UST#I II <br /> 5 I <br /> Product <br /> Facility Contact: Title: Phone: <br /> P-LA V-A� <br /> Motoanel: Piping system: Overfill prevention:ni� Itcressurized <br /> ❑Suction ❑Gravity Mechanical ❑Audible/visual <br /> Ins ection type: Violations: <br /> Routine ❑Monitoring Certification ❑Installation ❑Other: ❑MI-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=California Code of Regulations V R <br /> # Code Section V <br /> 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 Ml <br /> 8 CCR 2643(d) Daily monitoringof suction piping( re-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 /> 11 CCR 2630(d) UST system monitoring equipment is properly located to detect a leak M1 <br /> 12 HSC 25291 UST system monitoring equipment is operational M2 <br /> 13 CCR 2636(f)(1) Continuous monitoring system for underground piping&UDC is present Ml <br /> 14 CCR 2631 a Primary containment is pToduct tight <br /> 15 HSC 25291 (a)(2) Secondary containment for UST is tight <br /> 16 CCR 2636(c)(1) All releases in secondary piping flow to a collection sum <br /> 17 HSC 25291 ( Line leak detectors are installed M1 <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 1 CCR 2650 Recording/reporting of unauthorized releases Mi <br /> 23 CCR 2715 Designated Operator:(a)Statement from UST owner; (c-e)Monthly ins ection; f)Employee training <br /> 24 CCR 2638 a Annual monitoringcertification <br /> 25 CCR 2638(a) Annual line leak detector test (Mi) <br /> 26' HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 (4) Annual line tightness test Ml <br /> 28 1 CCR 2661 (f) Repair for tank/piping has had tightness test (M2 <br /> 29 CCR 2643 e) Biennial tightness test of gravity piping( re-Januar 1, 1984) <br /> 30 CCR 2643 d Triennial line test for conventional suction piping(pre-January 1, 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(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 INSPECTOR: PHONE: UIC <br /> W Irk . f& T,1� k4 �� Septic system: <br /> �V 'l 0 Serves>_20 people/day <br /> RECEIVE TITLE: C Receives other than sanitary waste <br /> Other disposal methods: <br /> Dry wells/French Drains <br /> EHD 23-02-002 <br />