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n SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, California 95202-3029 Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sigov.org UNDERGROUND STORAGE, TANK (TISTI PROGRAM 1NCPVCT1nN RvpnRT Facility name: Designated Operator: Inspection Date: 69 Facility address: OujProduct UST # Facility Contact: \ Title: Phone: /�2/� Q MonnitoringP el: tiR S P' ing system: Pressurized ❑ Suction ❑ Gravity Overfill prevention: ❑ Mechanical udible/visual Inspection ❑ Routine Monitoring Certification ❑ Installation ❑ Other: Violations: ❑ MI-RDetect 2-RPrev ❑ M-3 Both # Code Section eulations V R VIOLATION(S) HSC=California Health & Safety Code; CCR=Califomia Code ofg V=Violation; RV=Repeat Violation V 1 HSC 25284 : Permit too ate 2 CCR 2637 Secondary containment` test performed 3 CCR 2711 b)'& c Current Unified Program Consolidated Forms on file with EHD(Facility and tank form) 4 HSC 25292.2 Certification of financial responsibility and CFO letter 5 CCR 2632 b Monitoring Program(Monitoring & Response Plan is current and approved by the local agency. 6 CCR 2712 i Monitoring Ian is onsite. 7 CCR 2712 b Maintenance & monitoring records Ml 8 CCR 2643 d Daily,monitoring of suction piping (pre -January, 1, 1984 9 HSC 25292.1 UST system isoperated to prevent unauthorized release 10 CCR 2632 (c)(2) UST monitoring system is present (Ml 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak M1 12 HSC 25291 b UST system monitoring equipment isoperational M2 13 CCR 2636 1 Continuous monitoring system for underground piping & UDC is present M1 14 1 CCR 2631 a Primary containment is product tight 15 1 HSC 25291 (a)(2) Secondary containment for UST is tight 16 CCR 2636 (c)(1) All releases in secondary piping flow to a collection sum 17 HSC 25291 Line leak detectors are installed M1 18 CCR 2635 (b)(1) L Spill container M2) 19 CCR 2635 (b)(2) Overfill prevention system (M2) 20 CCR 2636 (a) Conventional suction piping shall have continuous monitoring & 2° containment 21 HSC 25291 (e) Water in 2° containment analyzed & properly disposed of 22 CCR 2650 Recording/reporting of unauthorized releases (M1) 23 CCR 2715 DesignatedOperator: (a) Statement from UST owner; (c -e) Monthly inspection; Employee training 24 CCR 2638 a Annual monitoring certification 25 CCR 2638 a) Annual line leak detector test (M1) 26 HSC 25284.2 Annuals ill containment testing 27 CCR 2636 4 Annual line tightness test M1) 28 1 CCR 2661 Repair for tank/piping has had tightness test M2) 29 1 CCR 2643 a Biennial tightness test of gravity piping(pre-January I, 1984 30 CCR 2643 d) Triennial line test for conventional suction piping (pre-January1, 1984 M1 31 HSC 25292.5 Double walls stem located within 1000' of public well-ELD 32 CCR 2661 Permit to repair UST system 33 HSC 25286 a Permit to alter monitoring system 34 HSC 25298 b) Permit to temporarily close UST system 35 1 HSC 25298 c Permit to close UST system 36 HSC 25299 (a)(9) Disabling leak detection devices 37 HSC 25298 a Illegal abandonment of UST system 38 Other: EHD INSP CTOR: 10 ,L* 42 PHONE: . UIC Septic system: Serves people/day Receives other .than sanitary waste Other disposal methods il - Dry welts/French [pains RECEIVED BY: TITLE: TITLE: /� /� C.. -G'" `— EHD 23-02-002 REV 05/07