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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <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 STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> Facility address: UST# <br /> 'Product all <br /> Facility Contact: Title: Phonf: <br /> A r <br /> Overfill prevention: <br /> Lo— Piping <br /> El Suction El Gravity echanical El Audible/visual <br /> M, P* Piping system: <br /> Mon' anel: <br /> 02 <br /> Inspection type: Violations: <br /> 0 M I-RDetect 0 M2-RPrev -3 Both <br /> 0 i n e Lonitoring Certification El El Installation ❑Other: Violations: <br /> VIOLATION(S) HSC=Califomia Health&Safety Code;CCR=Califia Code of Regulations ' V R <br /> # Code Section ornV=Violation;RV=RSpeat Violation V <br /> I HSC 25284 Permit tooperate <br /> 2 CCR 2637 Seconda 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 res2onsibili!X and CFO letter <br /> 5 CCR 2632(bMonitorinProgram(Monitoring&Response Plan)is current and approved by the local agency. <br /> 6 CCR 2712(i) Monitorinlan is onsite. <br /> 7 CCR 2712(b) Maintenance&monitoring records (MI) I <br /> 8 CCR 2643 dDaily monitoring of suction 2i inre-Janusa, 1, 1984) <br /> 9 1 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632 c)(2) UST monitoring system is present (M1) <br /> 11 CCR 2630(d) UST system monitoring equipment is properly located to detect a leak Ml� >< <br /> 12 HSC 25291 (bUST system monitorinequipment isoperational (M2) <br /> 13 CCR 2636 1 Continuous monitoring system for under round piping&UDC is present (M 1) <br /> 14 CCR 2631 (a) Primary containment is product ti ht <br /> 15 1 HSC 25291 a)(2Secondary containment for UST is tight <br /> 16 CCR 2636 jcI) All releases in seconds a pi2inflow to a collection sump <br /> 17 HSC 25291 Line leak detectors)are installed (M 1) <br /> 18 CCR 2635 bI) Spill container (M2) <br /> 19 CCR 2635(b)(2) Overfill prevention system (M2) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitorina&2'containment <br /> 21 HSC 25291 (c) Water in 2'containment anal zed&properly disposed of <br /> 22 CCR 2650 RecordinL/E2ortinof unauthorized releases (M 1) <br /> 23 CCR 2715 Desianated Operator:(a)Statement from UST owner; (c-e)Monthly inspection-,(t)Employee t2M' Lin�. <br /> 24 CCR 2638 a) Annual monitorincertification <br /> 25 CCR 2638(a) Annual line leak detector test (M1) <br /> 26 HSC 25284.2 Annual s ill containment testing <br /> 27 CCR 2636 4) Annual line tightness test <br /> 28 CCR 2661 (f) Repair for tank/2i2ina has had tiEhtness test (M2) <br /> 29 CCR 2643(e) Biennial tiahtness test of ravity piping(pre-Janus 1, 1984) <br /> 30 CCR 2643 d) Triennial line test for conventional suction piping( re-Janus a 1, 1984) (M 1) <br /> 31 HSC 25292.5 Double wall system located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to re air 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) Pen-nit to close UST s stem <br /> K, <br /> 36 HSC 25299(a)(9) Disabling leak detection devices <br /> 37 HSC 25298 a) Illegal abandonment of UST system <br /> 38 Other: I <br /> EHD INSPECTOR: PHONE: UIC, <br /> 4e 0.1 Sotic system: <br /> Serves�!20 people/day <br /> RECEIVED BV.Z" TITLE- Receives other than sanitary waste <br /> Other disposal methods: <br /> Dry wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />