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'�` . • DATE 11 Q <br /> PR# <br /> PAGE <br /> PUBLIC HEALTH SERVICES SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E. Weber Ave., Third Floor, Stockton, CA 95202 <br /> (209) 468-3420 <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility Name 5o;2�.- StnD Address . c10 <br /> Facilty Contact.,J1 i 1 r­?,%h Title Iqll ., c ;?v' Phone # <br /> UST# 15 Product 0L_ i 0JST# ProductP-cUST#Product t;ie5�L(4,K JST#�Product _ <br /> Overfill Prevention: V/Audible/Vis}ial Mechanical Monitoring Panel:C�(k�rC <br /> Piping System: 11 Gravity Op-ressure ❑Suction / Violations: ❑ inor ❑Major <br /> Automatic Pum Shut Down Satisfies CCR 2636 ❑Yes VINO Dispenser Pan: VYes ❑ No <br /> INSPECTION TYPE: 9koutine vmonitoring Certification ❑Complaint ❑Install []Removal ❑Repair/Upgrade <br /> COMPANY NAME: TECHNICIAN NAME:_] 5tee-_r PHONE•IJO ("io0 c1 <br /> VIOLATION(S) <br /> The above facility is not in compliance with the following section(s) of Health & Safety Code (HSC) and/or <br /> California Code of Regulations (CCR): <br /> 1 HSC 25284 Permit to operate 19J CCR 2712 (i) Monitoring &response plan <br /> 2 CCR 2637 Secondary cont testing (6 is on site <br /> / month/36 month) 20__ZCCR 2712 (b) Maintenance &monitoring <br /> 3 V CCR 2711(b) &(c) Current State Forms A& B records <br /> 4 HSC 25292.2 Certification of financial 21 CCR 2636 (f)(4) Annual line tightness test <br /> responsibility and letter from 22 CCR 2630(d) Annual line leak detector test <br /> chief financial officer 23 CCR 2630 (d) Annual monitoring <br /> 5 CCR 2630(d) Continuous monitoring certification <br /> system for UST system 24 CCR 2643 (d) Daily monitoring of suction <br /> 6 CCR 2636 (c)(1) All releases in secondary piping that is not <br /> piping flow to a collection continuously monitored <br /> sump 25 CCR 2643 (d) Triennial tightness test of <br /> 7 HSC 25291 (e) Water in secondary(20) cont suction piping that is not <br /> 8HSC 25291 (f) Automatic line leak continuously monitored <br /> detector(s) 26 CCR 2643 (e) Biennial tightness test of <br /> 9---V/—CCR 2636 (f)(1) Continuous monitoring gravity piping that is not <br /> system for underground continuously monitored <br /> piping 27 CCR 2662 Upgrade requirements for <br /> 10 CCR 2632 (c)(2) Continuous monitoring UST system <br /> system for UST 28 CCR 2661 Permit to repair UST system <br /> 11 HSC 25291(a)(2) Secondary containment for 29 HSC 25286 (a) Permit to alter monitoring <br /> UST is tight system <br /> 12 CCR 2636(f)(1) Continuous monitoring 30 HSC 25298 (a) Illegal abandonment of UST <br /> system for dispenser system system <br /> 13 CCR 2635(b)(1) Spill container 31 HSC 25298(b) Permit to temporarily close <br /> 14 CCR 2635 (b)(2) Overfill prevention system UST system 11, <br /> 15 CCR 2631 (a) Primary containment is 32 HSC 25298(c) Permit to close UST system <br /> product-tight 33 HSC 25291 (e) Water in 20 cont analy7,pd <br /> 16 HSC 25292.1 UST system is operated to and properly disposed of <br /> prevent unauthorized release 34 CCR 2640 (e) Single wall component within <br /> 17 CCR 2650 Recording/reporting 1 000'of Public Well, no ELD <br /> unauthorized release 36 CCR 2635(a)(2)(A)Cathodic protection testing <br /> 18 VCCR 2632 (d) Monitoring &response plan 35 Violation(s) not listed above <br /> EHD INSPECTOR: PHONE: - <br /> RECEIVED BY: ,, i ` TITLE: PHONE: Z <br />