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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,California 95202-3029 <br /> Telephoner(209)468-3420 Fax.(209)468-3433 Web,www.sigov.or /P ehd <br /> UNDERGROUND STORAGE A. (UST) PROGRAM INSPECTION <br /> Facility name: Designated Operator: Inspection Date: <br /> -Ap- W &Iocbl <br /> Facility address: UST# , <br /> 7-201 (--J L-- `� <br /> Product _ p' <br /> Facility Contact: rrej, Title: Phone: , <br /> Moni oring Panel: Piping system: Overfill prevention: <br /> essurized ❑Suction ❑Gravi!y I ❑Mechanical Audible/visual `e, <br /> Inspection type: N Violations: <br /> A?Ijto ,=�cnitoring Certification ❑Installation ❑Other: 1 ❑Ml-RDetect 2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=Califomia Health&Safety Code;CCR=California Code of Regulations V <br /> # Code Section <br /> V=Violation; RV=Re eat Violation <br /> V <br /> HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test performed <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 responsibility and CFO letter <br /> 5 CCR 2632 b Monitoring Program Monitoring&Response Plan)is current and approved by the local agency. <br /> 6 CCR 2712 i) Monitoring plan is onsite. <br /> 7 CCR 2712 b Maintenance&monitoring records M1 <br /> 8 CCR 2643 d) Daily monitoring of suction piping( re-Janua , 1, 1984) <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632 c)(2) UST monitoring system is present (M 1) <br /> 1 1 CCR 2630 d UST system monitoring equipment is properly located to detect a leak (M 1) <br /> 12 HSC 25291 6 UST system monitoring equipment isoperational ('*12) <br /> 13 CCR 2636 1 Continuous monitoring system for under round piping&UDC is present 1 <br /> 14 CCR 2631 (a) Primary containment is product tight <br /> 15 HSC 25291 (a)(2)_ SecondaEycontainment for UST is ti ht <br /> 16 1 CCR 2636(c)(1) All releases in secondary piping flow to a collection sum <br /> 17 HSC 25291 Line leak detectors are installed fl <br /> 18 CCR 2635(b)(1) Spill container (M2) <br /> 19 CCR 2635 b) 2 Overfill 2revention 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& ro erly dis osed of <br /> 22 1 CCR 2650 Recording/reporting of unauthorized releases M1) <br /> 23 CCR 2715 Designated Operator:(a)Statement from UST owner; (c-e)Monthly ins ection;(f)Employee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638 a) Annual line leak detector test (M1) <br /> 26 HSC 25284.2 Annuals ill containment testin <br /> 27 CCR 2636(D(4) Annual line tightness test M1) <br /> 28 CCR 2661 t) R22air for tank/eiping has had tightness test (M2) <br /> 29 CCR 2643 e Biennial tightness test of gravity pipingre-Janua 1, 1984 <br /> 30 CCR 2643 d) Triennial line test for conventional suction piping(pre-January 1, 1984) (M 1) <br /> 31 HSC 25292.5 Double walls stem located within 1000'of ublic well-ELD <br /> 32 CCR 2661 Permit to re air UST system <br /> 33 HSC 25286 a Permit to alter monitorinE system <br /> 34 HSC 25298 b) Permit to temporarily close UST s stem <br /> 35 HSC 25298 c) Permit to close UST system- <br /> 36 <br /> stem36 HSC 25299(a)(9) Disabling leak detection devices <br /> 37 HSC 25298 a) Illegal abandonment of UST system <br /> 38 Other: - <br /> EHD INSPECTOR: PHONE: UIC <br /> Septic system: <br /> Serves>_20 people/day <br /> RECEIVED BYTITLE: —Receives other than sanitary waste <br /> Other disposal methods: <br /> -Dry wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />