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SAN JOAQUINk ENVIRONMENTAL HEALTH DEPARTmENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> Telephone.(209)468-3420 Fax.(209)464-0138 Web.www.sjgov.org/ehd <br /> Lt�O% <br /> UNDERGROUNDT GET (UST) INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> Facility address: UST#f P /' <br /> Product <br /> Facility Contact: Title: Phone: <br /> Mpnitoring Panel: Piping system: Overfill prevention: <br /> 0 Pressurized 0 Suction 0 Gravity 0 Mechanical Audible/visual <br /> Inspection type: Violations: <br /> Routine Monitoring Certification 0 Installation 0 Other: 0 M1-RDetect 0 M2-RPrev 0 M-3 Both <br /> VIOLATION(S)HSC=Califomia Health&Safety Code;CCR=Califomia Code of Regulations V R <br /> # Code Section V <br /> V=Violation;RV=Re eat Violation <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test rformed <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 reM2nsibiliyand 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) Monitoring&response plan is onsite <br /> 7 CCR 2712_(b) Maintenance&monitorin records l <br /> 8 CCR 2643 d Daily monitoring of suction Riping(pre-Jamin, 1,1984) <br /> 9 HSC 25292.1 UST system is 2perated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is 2LeEent M1 <br /> 11 CCR 2630(d) UST system monitoring equipment is properly located to detect a leak Mi) <br /> 12 HSC 25291 ) UST s tem monitoring ui ment is operational M2 <br /> 13 CCR 2636(f)(1) Continuous monitoring tem for underground piping&UDC is present 1 <br /> 14 CCR 2631 a PfiTM containment is 2roduct tight <br /> 15 HSC 25291 (a)(2) Secondary containment for UST is ti t <br /> 16 CCR 2636(c)(1) All releases in seconds piping flow to a collection sum <br /> 17 HSC 25291 Line leak detectors are installed (MI) <br /> 18 CCR 2635 1 Spill container (M2 <br /> 19 CCR 2635(b)(2) Overfill pEvention system (M2) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&21 containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&propuly dis22sed of <br /> 22 CCR 2650 Recording re rtin of unauthorized releases MI <br /> 23 CCR 2715 Designated Operator(a)Statement from UST owner; (c-e)Monthly inspection;(f)Employee training <br /> 24 CCR 2638(a) Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test (Mi) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 f)(4) Annual line tightness test (M1 <br /> 28 CCR 2661 f) Repair for tank/piping has had ti tness test 142 <br /> 29 CCR 2643(e) Biennial tightness test of gravity piping(pre-January 1, 1984) <br /> 30 1 CCR 2643 d Triennial line test for conventional suction piping(pre-January1, 1984 Ml <br /> 31 1 HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to repair UST system <br /> 33 HSC25286(a) Permit to alter -nonitofina system <br /> 34 HSG 25298(b) Permit to temporarily close UST system <br /> 35 HSC 25298(c) Permit to close UST system <br /> 36 HSC 25299(a)(9) Disabling leak detection devices <br /> 37 HSC 25298 a) Ille al abandonment of UST system <br /> 38 Other: <br /> EHD INSP CTOR: PHONE: UIC <br /> - . <br /> cx Septic system. <br /> FA <br /> i_;Serves?20 people/day <br /> RECEIVES BY° ` TITLE: Ci Receives other than sanitary waste <br /> - Other disposal methods: <br /> U Dry wells/French Drains <br /> EHD 23-02 <br /> 1/3/07 <br />