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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTN <br /> 600 East Main Street, Stockton, California 952,,2-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Facility name: <br /> De ignaated Operator: Inspection <br /> Pg-w-, ht- 5Y� VVr� Da <br /> lh- <br /> Fac1 7 <br /> ilit�ddress: / <br /> lUST# <br /> i <br /> 7 <br /> 'Product <br /> il'ty ontapt. Title: Phone: <br /> 19 -1 fl <br /> r <br /> itoringnel: \ Pipind system. Overfill prevention: <br /> (/✓1 U Pressurized ❑Suction ❑Gravity .mechanical ❑Audible/visual <br /> spection type: i ations: <br /> Routine Monitoring Certification ❑Installation ❑Other: 1-RDetect ❑M2-RPrev ❑M-3 Both <br /> # Code Section VIOLATION(S) HSC=California Health&Safety Code; R=California Code of Regulations V R <br /> V=Violation; RV=Re eat Violation V <br /> 1 HSC 25284 Permit too erste <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 b Monitoring Program(Monitoring&Response Plan is current and approved by the local agency. <br /> 6 CCR 2712 i Monitoring-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 monitorings stem is present (M1) <br /> 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak M1) <br /> 12 HSC 25291 b UST system monitoring equipment is operational (M1) <br /> 13 CCR 2636(f)(1) Continuous monitoring system for underground piping&UDC is present M1) <br /> 14 CCR 2631 a Primary containment is product tight <br /> 15 HSC 25291 (a)(2) Secondary containment for UST is tight <br /> 16 CCR 2636(c)(1) All releases in secondary pipingflow to a collection sum <br /> 17 HSC 25291 f Line leak detector(s)are installed M1) <br /> 18 CCR 2635(b)(1) Spill container <br /> 19 CCR 2635(b)(2) Overfill prevention system (M2) <br /> M2) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&20 containment <br /> 21 HSC 25291 (e) Water in 20 containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/reportingRecording/reporting of unauthorized releases Ml) <br /> 23 CCR 2715 Designated Operator: a Statement from UST owner; (c-e)Monthly inspection; 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 testing <br /> '27 CCR 2636 4 Annual line ti htness test M1 <br /> 28 CCR 2661 Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 a Biennial tightness test of gravity pipingre-Janus 1, 1984 <br /> 30 CCR 2643 d Triennial line test for conventional suction piping(pre-January 1, 1984) (M1) <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 Disabling leak detection devices <br /> a 9 2 <br /> 37 HSC 25298 a Ille al abandonment of UST Tystem <br /> 38 Other: <br /> EH 1 SP C UIC <br /> 414 Septic system: <br /> ❑Serves 20 people/day <br /> R CEIVED BY: TITLE: ❑Receives other than sanitary waste <br /> _Other disposal methods: <br /> ❑Dry wells/French Drains <br /> EHD 23-02-002 REV 8/08 <br />