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°�qu�N ° • SAN JOAQUIN COUNTY • <br /> N ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> �r l�vis <br /> 13d (0 <br /> Facility <br /> Facility address: � t UST# <br /> '700 <br /> "Product <br /> Facility Contact: Title: Phone: <br /> Monitoring Panel: Piping system: Overfill prevention: <br /> (/le -1-L c Sv D'0ressurized [I Suction ❑Gravity ('Mechanical ❑Audible/visual <br /> Inspection type: Violations: <br /> D�Ko-utine 29fAonitorin Certification ❑Installation ❑Other: ❑M1-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=Califomia 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 /> 6 CCR 2712 i Monitoring&response plan is onsite <br /> 7 CCR 2712 b Maintenance&monitoring records Ml <br /> 8 CCR 2643 d Daily monitoring of suction piping(pre-January, 1, 1984 <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present Ml <br /> 11 CCR 2630(d) UST system monitoring equipment is properly located to detect a leak Ml <br /> 12 HSC 25291 UST system monitoring equipment isoperational M2 <br /> 13 CCR 2636(f)(1) Continuous monitoring system for underground piping&UDC is present Ml <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 HSC 25291 Line leak detector(s)are installed Ml <br /> 18 CCR 2635 1 Spill container M2 <br /> 19 CCR 2635(b)(2) Overfill prevention system M2) <br /> 20 CCR 2636(a) Conventional suction piping 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 Ml <br /> 23 CCR 2715 Designated Operator:(a)Statement from UST owner; (c-e)Monthly inspection;(f)Employee training <br /> 24 CCR 2638(a) Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test (M1) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636(f)(4) Annual 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 of gravity piping( re-Januar 1, 1984) <br /> 30 CCR 2643(d) Triennial line test for conventional suction piping(pre-January1, 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 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 /> r ( A A^ q— <br /> / ! Septic system: <br /> IV 'l/_ `('-'O [1 Serves>_20 people/day <br /> RECEIVED BY: TITLE' ❑Receives other than sanitary waste <br /> Other disposal methods: <br /> L ❑Dry wells/French Drains <br /> EHD 23-02 <br /> 1/3/07 <br />