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AN.JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 Fax. (209)468-3433 a .sigov.orC1/ehd <br /> UNDERGROUND STORAGE TANK JUST) INSPECTION <br /> Facility name: Designated Operator: Inspection <br /> # Date: <br /> Facility address: UST <br /> t product <br /> Facility Contact: _Title: Phone: <br /> Monitoring Panel: Piping system: Overfill prevention: <br /> , <br /> C3-Pressurized O Suction ❑Gravity Mechanical ❑Audible/visual <br /> Inspection type: PMI-RDetect <br /> olations: <br /> R-Routine Monitoring Certification D Installation D Other ❑M2-RPrev D M-3 Both <br /> VIOLATION(S) HSC=Califomia Health Safety Code;CCR=California Code of Regulations V R <br /> # Code Section V <br /> V=Via{ation; RV=Re eat Violation <br /> 1 HSC 25284 Permit to operate <br /> 2 CCR 2637 Seconds containment test performed <br /> 3 CCR 2711 b & c Current Unified Program Consolidated Forms on file with EHD(Facilily and tank form <br /> 4 HSC 25292.2 Certification of financial res onsibili and CFO letter <br /> 5 CCR 2632 b Monitoring Program(Monitoring&Resp2nse Plan is currentand approved by the local a enc . <br /> 6 CCR 2712 i Monitoring plan is onsite. <br /> 7 CCR 2712 b Maintenance&monitorin records 1 <br /> 8 CCR 2643 d Daily monitoring of suction 2iping(pre-Janua!y, 1, 1984 <br /> 9 HSC 25292.1 UST system is operated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present 1) <br /> 11 CCR 2630 d UST system monitoring a ui ment is properly located to detect a leak 01 <br /> 12 HSC 25291 b UST system monitoring equipment is operational 1 <br /> 13CCR 2636 1 Continuous monitoring system for underground pi2ing&UDC is present 1 <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 1 All releases in secondary pipingflow to a collection sum <br /> 17 HSC 25291 Line leak detectors are installed 1 <br /> 18 CCR 2635(b)(1) Spill container 2 <br /> 19 CCR 2635(b)(Q Overfill prevention system 2 <br /> 20 CCR 2636(a) Conventional suction pipigg shall have continuous monitoring&20 containment <br /> 21 HSC 25291 (e) Water in 20 containment anal ed&eroperly disposed of <br /> 22 CCR 2650 Recording/repoong of unauthorized releases 7 <br /> 23 CCR 2715 Designated Operator: a Statement from UST owner; c-e Monthly inspection; Employee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638 a Annual line leak detector test (MI) <br /> 26 HSG 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 4 Annual line tightness test 1 <br /> 28 CCR 2661 Repair for tank/piping has had tightness test 2 <br /> 29 CCR 2643 a Biennial fi fitness test of gravity pipingre-Janus 1, 1984 <br /> 30 CCR 2643 d Triennial line test for conventional suction 2iping( re-Janus 1, 1984) (M1 <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 1 HSC 25286 a Permit to alter monitorin system <br /> 34 HSC 25298 b Permit to temporarily dose UST system <br /> 35 HSC 25298 c Permit to close UST system <br /> 36 HSC 25299 Disabling leak detection devices <br /> (a)(9)(%2) <br /> 37 HSC 25298 a Illegal abandonment of UST astern <br /> 38 1 Other: <br /> EHD INSPECT PHONE: UIC <br /> F Septic system: <br /> ❑Serves 220 people/day <br /> RECEIVED BY: TITLE:, ❑Receives other than sanitary waste <br /> Other disposal methods: <br /> ❑Dry wells/French Drains <br /> EHD 23-02-002 REV 8/08 <br />