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a - <br /> ' DATE�k o"a <br /> EALTH SERVICES SAN JO <br /> PUBL. HAQUIN, JUNTY PR# <br /> ENVIRONMENTAL fiEALTH DIVISION PAGE l of 3 <br /> 304 E.Weber Ave.,Third Floor, Stockton, CA 95202 <br /> (209)468-3420 - <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility Namec .�nQ Facility Address 5®5 w • .yC� y`c�, <br /> Facilty Contact SO"D-- Title Phone# S'ucb� <br /> UST# 5 Product UST# P/roductUST# Product �® UST# Product <br /> Overfill Prevention: ❑AudibleNyressure <br /> I �Mlechanical Monitoring Panel: tNMu <br /> Piping System: ❑Gravity ❑Suction / Violations: ❑ Minor Mai-r A� <br /> Automatic Pum Shut Down Satisfies CCR 2636 ❑Yes QNo Dispenser Pan: Oyes 11No ATTAVHIYIE <br /> INSPECTION TYPE: outine ❑Monitoring Certification ❑Complaint ❑Install ❑Removal ❑Repair/Upgra <br /> COMPANY NAME: TECHNICIAN NAME: PHONE: <br /> VIOLATION(S) <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 /> 1 HSC 25284 Permit to operate 20 CCR 2712 (b) Maintenance&monitoring <br /> 2 CCR 2637 Secondary cont testing(6records <br /> month/36 month) y 21 J/ CCR 2636 (f)(4) Annual line tightness test <br /> 3 / CCR 2711(b)& (c) Current State Forms A&B 22CCR 2636 (d) Annual line leak detector test <br /> 4--�PL—HSC 25292.2 Certification of financial 23�CCR 2630 (d) Annual monitoring certification <br /> responsibility and letter from 24 CCR 2643 (d) Daily monitoring of suction <br /> chief financial officer piping that is not continuously <br /> 5 CCR 2630 (d) Continuous monitoring system monitored <br /> for UST system 25 CCR 2643 (d) Triennial tightness test of <br /> 6 CCR 2636(c)(1) All releases in secondary piping suction piping that is not <br /> flow to a collection sump continuously monitored <br /> 7 HSC 25291 (e) ' Water in secondary(20)cont 26 CCR 2643 (e) Biennial tightness test of gravit, <br /> 8 HSC 25291 (f) Automatic line leak detector(s) piping that is not continuously <br /> 9 CCR 2636 (f)(1) Continuous monitoring system monitored - <br /> for underground piping 27 CCR 2662 Upgrade requirements for UST <br /> 10 CCR 2632(c)(2) Continuous monitoring system system <br /> for UST 28 CCR 2661 Permit to repair UST system <br /> 11 HSC 25291(a)(2) Secondary containment for 29 HSC 25286 (a) Permit to alter monitoring <br /> UST is tight system <br /> 12 CCR 2636 (f)(1) Continuous monitoring system 30 HSC 25298(a) Illegal abandonment of UST <br /> for dispenser system system <br /> 13 CCR 2635 (b)(1) Spill container 31 HSC 25298(b) Permit to temporarily close US' <br /> 14 CCR 2635(b)(2) Overfill prevention system system <br /> 15 CCR 2631 (a) Primary containment is product- 32 HSC 25298 (c) Permit to close UST system <br /> tight 33 HSC 25291 (e) Water in 20 cont analyzed and <br /> 16 HSC 25292.1 UST system is operated to properly disposed of <br /> prevent unauthorized release 34 CCR 2640 (e) Single wall component within <br /> 17 CCR 2650 Recording/reporting 1 000'of Public Well, no ELD <br /> unauthorized release 35 CCR 2635(a)(2)(A)Cathodic protection testing <br /> 18 CCR 2632(d) Monitoring &response plan 36 H&SC 25299(a)(9)Disabling leak detect.devices <br /> 19 CCR 2712 (i) Monitoring&response plan is 37 Violation(s)not listed above <br /> on site <br /> EHD INSPECTO PHONE: <br /> RECEIVED BY: TITLE: PHONE: <br /> ,. I IN fTIIl�ICT/t AICD/rav t/1 SM1 <br />