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SAN JOA►QUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,California 95202-3029 <br /> Telephone,(209)468-3420 Fax:(209)468-3433 Web,www.slgov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> h 5 �^✓ C� - t S„r. <br /> Facility address: ST# Ll <br /> , <br /> !/ �GI'C/G» <br /> " 'Product <br /> Facility Contact: r1.t le: Phone: , <br /> Monitoring Anel: Piping ystem: Overfill prevention: <br /> spPressurized Suction ElGravit echanical El <br /> Inspection type: Violations: <br /> utine —'��Monitoring Certification ❑Installation ❑Other: ❑MI-RDetect km2-RPrev ❑M-3 Both <br /> # Code Section <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=Califomia Code of Regulations V V=Violation;RV=Re eat Violation V <br /> I HSC 25284 Permit too erste <br /> 2 CCR 2637 SecondLry containment test performed <br /> 3 CCR 2711 b)& e Current Unified Program Consolidated Forms on file with EHD(Facility and tank form) <br /> 4 HSC 25292.2 Certification of financial res2onsibility 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&monitorin records M1 <br /> 8 CCR 2643 d Daily monitoring of suction piping( re-Janus , 1, 1984) <br /> 9 HSC 25292.1 UST system iso erated to 2revent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present (M1) <br /> I I CCR 2630 d UST system monitoring a ui ment is properIX located to detect a leak (M 1) <br /> 12 HSC 25291 b) UST system monitorin equipment isoperational (M2) <br /> 13 CCR 2636 t I Continuous monitorin s stem for under round piping&UDC is present (M 1 <br /> 14 CCR 2631 a Primary containment is product tight <br /> 15 1 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 I) S ill container (M2) <br /> 19 CCR 2635 b)2 Overfill prevention system (M2) <br /> 20 CCR 2636(a) Conventional suction 2ij2ing shall have continuous monitoring&2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases 1) <br /> 23 CCR 2715 Desi nated O erator:(a)Statement from UST owner; (c-e)Monthly inspection,(f)Em to ee training <br /> 24 CCR 2638 a Annual monitorin certification <br /> 25 CCR 2638(a) Annual line leak detector test (Ml) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 1 CCR 2636(t)(4Annual line tightness test (MI) <br /> 28 CCR 2661 Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 e Biennial tightness test ofravit i in re-Janus 1, 1984 <br /> 30 CCR 2643 d) Triennial tine test for conventional suction pi2in (2re-Januaa1, 1984) (M1) 11 <br /> 31 HSC 25292.5 Double walls stem located within 1000'of 2ublic well-ELD <br /> 32 CCR 2661 Permit to re air UST s stem <br /> 33 1 HSC 25286 a Permit to alter monitoring system <br /> 34 HSC 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) Illegal abandonment of UST system <br /> 38 Other: <br /> EHD INSPECTOR: PHONE: UIC <br /> ®7G,t Sentic system: <br /> Serves>:20 people/day <br /> REC TITLE: -Receives other than sanitary waste <br /> Other disposal methods: <br /> Dry wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />