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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, California 95205-6232 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sicehd.com UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT FacilityFacility Inspection Name: ��S� e V m Phone: Date: - ` f,6 Facility CERS Address: ] yd a ID: Inspection L Title: �v Phone: Contact: Inspection T /,(I y v*/ /7 Program: Type: l/ //'r r L/ Consent Given For. Consent LAnspection a.14totos o-8Tm—pling Given By: (! Service Tech Exp. 4 ) )9jJ7 Designated Exp. Onsite: r►( a Date: Operator: Date: Service Technician p Manufacturer's Training: V CCR=California Code of Regulations HS(9 Healty and Safety Code CFR=Code of Federal Regulations V=Violation R=Repeat COS=Corrected on site during inspection Pile Review ' V R COS 101 HSC 25284 No permit to operate(V650) ❑ ❑ ❑ 102 HSC 25284(a)(3) No written agreement between tank owner and tank operator to monitor the tank syE tem(\/735) ❑ ❑ ❑ 103 HSC 25292.2 Current financial responsibility documents not submitted(V720) ❑ ❑ ❑ 104 CCR 2711 UST Operating Permit Application for Facility and Tank information not submitted or current(V651) ❑ ❑ 105 HSC 25286(c) Current BOE number not submitted(V652) ❑ ❑ ❑ 106 CCR 2632 Monitoring and response plans not current or approved by the EHD(V654) ❑ ❑ 107 CCR 2632(d)(1)(C) Plot plan/site map not submitted or failed to completely show where monitoring is performed(V655) ❑ ❑ ❑ 108 CCR 2637(f), Failed to notify the EHD 48 hours prior to conducting testing(V671) ❑ ❑ ❑ 2638(e) 109 CCR 2637 Failed to test secondary containment(\/660) ❑ ❑ ❑ 110 CCR 2637(e) Failed to submit secondary containment test report within 30 days(\1662) ❑ ❑ ❑ 111 CCR 2638(a) Failed to test monitoring and leak detection equipment annually(V659) ❑ ❑ ❑ 112 HSC 25284.2 Failed to test spill containers annually(V661) ❑ ❑ ❑ 113 CCR 2638(d) Failed to submit monitoring system certification test report within 30 days(V823) ❑ ❑ ❑ 114 CCR 2636(f) Failed to perform 0.1 gph annual line test for pressurized piping without fail safe or shut down(V663) ❑ ❑ ❑ 115 CCR 2715(a) Failed to inform the EHD of a change of designated operator within 30 days(\/658) ❑ ❑ ❑ 116 CCR 2715 Designated operator,service tech or installer did not possess current ICC certification(V717) ❑ ❑ ❑ 117 HSC 25292.5 Failed to conduct ELD testing on a system located within 1 000'of a public well(V672) ❑ ❑ ❑ 118 HSC 25292.5 Failed to repair and retest system due to failed ELD test(V749) ❑ ❑ ❑ 119 CCR 2644.1(a)(5) Failed to submit ELD test results within 60 days(V669) o ❑ ❑ 120 CCR 2663 Failed to inspect a lined or repaired steel tank within 10 years of lining and every 5 years after(V666) ❑ ❑ ❑ 121 CCR 2663 Failed to submit tank lining certification within 30 days or to conduct proper tests(V667) ❑ ❑ ❑ 122 HSC 25299 Documents were falsified or misrepresented(V657) ❑ ❑ ❑ 123 CCR 2661 Permit to repair UST system not obtained(V673) o ❑ ❑ 124 CCR 2635(d) Failed to submit UST Certification of Installation/Modification(V840) ❑ ❑ ❑ 125 CCR 2712(f) Failed to submit a written response within 30 days of receiving an inspection report(V804) o ❑ ❑ 126 HSC 25404(e)(4) Failed to report program data electronically(V817) ❑ ❑ ❑ On Site Records ; V R COS 201 CCR 2712(b) Failed to maintain alarm logs and/or records of follow up actions(V725) ❑ ❑ ❑ 202 CCR 2712(b) Failed to maintain cathodic protection test records on site for at least 61/2 years(V733) ❑ ❑ ❑ 203 CCR 2712(b) Failed to maintain records of monitoring,repair,lining,and upgrades on site(V732) ❑ ❑ ❑ Received Inspector: Inspector By(initial): (t Phone: EHD 23-01 REV 08/07/15 Plage 1 UST INSPECTION PH-PORT