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� SAN JOAQUIN COUNTY <br /> OVIRONMENTAL HEALTH DEPARTMENT • J <br /> 304 East Weber Avenue,3`d Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)'468-3420 Fax:(209)468-3433 Web:�j og v.or /g ehd <br /> UNDERGROUND STORAGE TANK UST P RAM INSPECTION REPORT <br /> Facility name: LDesignated Operator: Inspection Date: <br /> G.P,tJ IF—f— t r.cX. 4,i r,. r• t;t c• �r � '( <br /> Facility address: UST# <br /> Y <br /> - m <br /> R. <br /> 'Product- <br /> Facility <br /> roductFacility Contact: Title: Phone: <br /> Monitoring Panels Piping system: Overfill prevention: <br /> t'L 3 Pressurized ❑Suction ❑Gravity D Mechanical ❑Audible/visual <br /> Inspection type: Violations: <br /> Routine Aonitoring Certification ❑Installation ❑Other: ❑M1-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATIONS) HSC=Califomia Health&Safety Code;CCR=California 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 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 c 2 D Monitoring&response plan is current and filed with the local agency <br /> i <br /> 6- CCR 2712,(i) Monitoring&response plan is onsite h w' <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 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present Mi <br /> 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak M1 <br /> 12 HSC 25291 UST s'stem monitoring equipment isoperational M2 <br /> 13 CCR 2636 1 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)(1) All releases in secondary piping flow to a collection sum <br /> 17 1 HSC 25291 Line leak detectors are installed M1 <br /> L2 , <br /> CCR 2635(b)(1) Spill container (M2 <br /> CCR 2635(b)(2) Overfill prevention system M2 <br /> CCR 2636;(a) Conventional suction piping shall have continuous monitoring&2°containment <br /> HSC 25291 (e) Water in 21 containment analyzed&properly disposed of wf <br /> CCR 2650 Recording/reporting of unauthorized,releases Ml <br /> 23 CCR 2715 Designated Operator:(a)Statement from UST owner; (c-e)Monthly inspection; Employee training <br /> 24 <br /> CCR 2638 a "Annual monitoring certification <br /> 25 CCR 2638 a Annual line leak detector test Ml <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> '27 CCR 2636 4 Annual line tightness test M1 <br /> '28 CCR 2661 Repair for tank/piping has had tightness test M2 <br /> 29. CCR 2643 a Biennial tightness test of gravity pipingre-Januar 1, 1984 <br /> 30 CCR 2643 d Triennial line test for conventional suction piping(pre-January7, 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 25298 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 INSPECTOR: PHONE: UIC <br /> Septic system: <br /> Serves>_20 people/day <br /> RECEIVED BY: j TITLE: ❑Receives other than sanitary waste <br /> I . Other disposal methods: <br /> Dry wells/French Drains <br /> F,HD 23-02-002 <br />