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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 Facility Facility Inspection Name: Address: Date: UST System Observations V R COS 330 CCR 2717.1(0 Deposited petroleum into a red tagged UST(V746) ❑ ❑ ❑ 331 HSC 25299(f(2) Tampered with or disabled leak detection devices or alarms(V692) ❑ ❑ ❑ 332 CCR 2631.1 UST system not compatible with the substance stored(V751) ❑ ❑ ❑ 333 HSC 25298(b) Failed to comply with temporary closure requirements(V747) ❑ ❑ ❑ 334 HSC 25298(c) Failed to comply with permanent closure requirements(V748) ❑ ❑ ❑ Non-Pressurized Piping V R COS 401 CCR 2636(a)(3) Suction piping not properly sloped or incorrectly located check valve(V705) ❑ ❑ ❑ 402 CCR 2643(d) Daily monitoring of suction pipe(pre-Jan 1984)not performed(V726) ❑ ❑ ❑ 403 CCR 2643(d) Triennial 0.1 gph line test for conventional suction piping not performed(pre-January 1984)(V664) Cl ❑ ❑ 404 CCR 2643(e) Biennial 0.1 gph test for gravity piping not performed(pre-January 1984)(V665) u ❑ ❑ Other Violations V R COS 2010 See below Unlisted Administration/Documentation violation(V736) ❑ ❑ ❑ 2030 See below Unlisted Operations/Maintenance violation(V743) ❑ Cl ❑ 2060 See below Unlisted Design/Construction violation(V745) ❑ ❑ ❑ SUMMARY OF VIOLATIONS CLASS I, CLASS ll, or MINOR—Notice to Comply ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. Received by(signature): Title: Date: Received by(printed name): Inspector: Inspector hone: EHD 23-01 REV 08/07/15 Page 3 UST INSPECTION REPORT