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• SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT - <br /> 304 East Weber Avenue,3rd Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.orp-/ehd <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Ins ection Date: <br /> Facility <br /> �address: UST# <br /> ` O 2 r' — ` � Product <br /> Facility Contact: Title: Phone: <br /> SAM � tEpu'Prrssurized <br /> 83 _Monitoring Panel: ping system: Overfill prevention:❑Suction ❑Gravity ❑Mechanical ❑Audible/visual <br /> Inspection type: Violations: <br /> Routine ❑Monitoring Certification ❑Installation ❑Other: ❑MI-RDetect 11 M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=California Code of Regulations V R <br /> # Code Section <br /> V=Violation;RV—Repeat Violation V <br /> I HSC 25284 Permit too crate <br /> 2 CCR 2637 Secondary containment test performed <br /> 3 CCR 2711 6 & 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 c 2 D Monitoring&response plan is current and filed with the local agency <br /> 6 CCR 2712 i Moriftoring&response plan is onsite <br /> 7 CCR 2712 b Maintenance&monitoring records M1 <br /> 8 CCR 2643 d Daily monitoring of suction piping(pre-January,_I, 1984) <br /> 9 HSG 25292.1 UST system is op crated to prevent unauthorized release <br /> 10 CCR 2632 c 2 UST monitorin system is present (MI) <br /> 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak Ml <br /> 12 HSC 25291 UST system monitoring equipment isoperational M2 <br /> 13 CCR 2636 (I) 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)(I All releases in secondary pipingflow to a collection sum <br /> 17 HSC 25291 Line leak detectors are installed M1 <br /> 18 CCR 2635(b)(1) Spill container (M2 <br /> 19 CCR 2635(b)(2) Overfill prevention system M2 <br /> 20 CCR:2636(a) Conventional suction piping shall have continuous monitoring&2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/reporfing of unauthorized releases MI <br /> 23 CCR 2715 Designated Operator: (a)Statement from UST owner; (c-c)Month!y inspection;(f)Employee trainin <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638 a Annual line leak detector test (M1) <br /> 26 1 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 4 Annual line ti htness test MI <br /> 28 CCR 2661(f) Repair for tank!`iping has had tightness test (M2 <br /> 29 CCR 2643 e Biennial tightness test of grayqy pipingre-Januar 1, 1984 <br /> 30 CCR 2643 d Triennial line test for conventional suction piping(pre-January 1,1984) (Ml <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 Permit to temporarily close UST system <br /> 35 HSC 2529$ c Permit to close UST system <br /> 36 HSC 25299(a)(9). Disabling leak detection devices <br /> 37 HSC 25298 a) Illegal abandonment of UST system <br /> 38 Other: <br /> EHD SPECTOR: PHONE: UIC <br /> Septic system. <br /> v ,>Oerves>_2o people/day <br /> RECEIVED Y: TITLE: -�Receives other than sanitary waste <br /> Other disposal methods: <br /> Dry wells/French Drains <br /> EHD 23-02 <br />