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SAN JOAQUIN COUNTY <br /> OVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3`d Floor, Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax: (209)468-3433 Web:www.sj og v.or <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: ; L i Designated Operator: Inspection Date: <br /> It1�2l 1ri�g <br /> Facility address: ? UST# <br /> Product �`7 <br /> Facility Contact: Title: Phone: <br /> 1' � 3 �o� <br /> Monitoring Panel: Piping system: Overfill prevention: <br /> Q C a'\j VPressurized ❑Suction ❑Gravity mechanical ❑Audible/visual <br /> Inspection type: �� Violations: <br /> outine I�FMonitoring Certification ❑Installation ❑Other: ❑M1-RDetect ❑M2-RPrev ❑M-3 Both <br /> VILATIN(S) HSC=California 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 SecondM containment test 2erforined <br /> 3 CCR 2711 )& 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)(2D Monitoring&res onse plan is current and filed with the local agency <br /> 6 CCR 2712 i Monitorin &response plan is onsite <br /> 7 CCR 2712 b Maintenance&monitoring records l <br /> 8 CCR 2643 d Daily monitoring of suction'piping re-Jami , 1, 1984 <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 1 CCR 2632(c)(2) UST monitorin system is 'resent Mi <br /> I 1 CCR 2630 d UST system monitoring equipment is properly located to detect a leak l <br /> 12 HSC 25291 UST system monitoring equipinent isoperational 2 <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping&UDC is present I <br /> 14 CCR 2631 a Primary containment is roduct tight <br /> 15 HSC 25291 a)(2) Secondary containment for UST is tight <br /> 16 CCR 2636(c)(1) All releases in second piping flow to a collection sump <br /> 17 HSC 25291 Line leak detectors are installed I <br /> 18 CCR 2635'(b)(1) S'ill container (M2) <br /> 19 CCR 2635 b)(2) Overfill prevention system 2 <br /> 20 CCR 2636(a) Conventional suction pipin shall have continuous monitoring' &2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&properly disposed of <br /> 22 CCR 2654 Recordin re ortin of unauthorized releases i <br /> 23 CCR 2715 Designated O erator:(a Statement from UST owner; (c-c)Monthly inspection;(f)Em loyee training <br /> 24 CCR 2638; a Annual monitoring'certification <br /> 25 CCR 2638(a) Annual line leak detector test ( l) <br /> 26 HSC 25284.2 Annual spill containment testing <br /> 27 CCR 2636 4 Annual line tightness test l <br /> 28 CCR 2661 ( Re air for tank/ iping has had tightness test M2 <br /> 29 CCR 2643 a Biennial tightness test of Eavity pipingre-Janua 1, 1984 <br /> 30 CCR 2643 d Triennial line test for conventional suction piping(pre-January 1, 1984 ?, ( i <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 raril 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 Ille al abandonment of UST system <br /> 38 Other: <br /> EHD INSPECTOR: PHONE: UIC <br /> Septic system: <br /> Serves>_20 people/day <br /> RECEIVED BY: TITLE: C Receives other than sanitary waste <br /> Other disposal methods: <br /> ❑Dry wells/French Drains <br /> FHD 23-02-002 <br />