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0 SAN JOAQUIN 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.sigov.org�eh <br />1 "0111 D1 111" tIll 1101 1111.11 M WI -191 I", WL 1 9 0 1 11 1 <br />Facility name: <br />Designated Operator: <br />Inspection Date: <br />10 <br />Facility address: <br />13 141 /A, <br />UST # <br />Product <br />Facility Contact: Title: Phone: <br />/34W L A7\, rte`:CC <br />Monitong Panel: <br />Wk ri� U <br />Piping system: <br />I ['Pressurized 11 Suction 0 Gravity <br />Overfill prevention: <br />0,14'echanical 11 Audible/visual <br />Inspection type: Violations: <br />@11toutine [��Monitoring Certification El Installation 11 Other: El M I -RDetect El M2-RPrev <br /># Code Section VIOLATION(S) HSC=Califomia Health & Safety Code; CCR=California Code of Regulations <br />V=Violation; ',V=REgeat Violation <br />11 M-3 Both <br />V R <br />V <br />I <br />HSC 25284 <br />Permit too2erate <br />2 <br />CCR 2637 <br />Secondary containment test perfortned <br />3 <br />CCR 2711 (b) & (c) <br />Current Unified Pro am Consolidated Forms on file with EHD ( acifity and tank form) <br />4 <br />HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />5 <br />CCR 2632 (b) <br />Monitoring Proram Monitoring & Response Plan) is current and approved by the local agenc <br />6 <br />CCR 2712 (i) <br />Monitoring 21an is onsite. <br />7 <br />CCR 2712 b) <br />Maintenance & monitoring records <br />(M 1) <br />8 <br />CCR 2643 (d) <br />Daily monitoring of suction2ina (pre-Januaa, 1, 1984) <br />9 <br />1 HSC 25292.1 <br />UST system isoperated to prevent unauthorized release <br />10 <br />CCR 2632 (c)(2) <br />UST monitorinsystem is present <br />(M1) <br />I I <br />12 <br />13 <br />CCR 2630 (d) <br />HSC 25291 b <br />CCR 2636 1f)(1) <br />UST system monitoring e uipment is properly located to detect a leak <br />UST system monitorinequi2ment iso2erational <br />Continuous monitoring system for underground piping & UDC is present <br />(M 1) <br />(M2) <br />(M 1) <br />14 <br />CCR 2631 a) <br />Primary containment is product ti ht <br />15 <br />HSC 25291 (a)(21 <br />SecondaLy containment for UST is tiht <br />16 <br />CCR 2636 (c)I) <br />All releases in seconds a 2ipinE flow to a collection sump <br />17 <br />1 HSC 25291 <br />Line leak detectors are installed <br />CCR 2635 (b)(1) <br />Spill container <br />(M2) <br />19 <br />CCR 2635 (b)(2) <br />Overfill prevention system <br />(M2) <br />2 IF18 <br />20 <br />CCR 2636 (a) <br />HSC 25291 (e) <br />Conventional suction piping shall have continuous monitoring & 2' containment <br />Water in 2' containment analyzed & properly disposed of <br />22 <br />23 <br />CCR 2650 <br />1 CCR 2715 <br />Recording/reporting of unauthorized releases <br />Desinated 02crator: (a) Statement from UST owner; ta Monthly inspection; (f) Em2loXee training <br />(M 1) <br />24 <br />25 <br />CCR 2638 (a) <br />CCR 2638 (a) <br />Annual monitorincertification <br />Annual line leak detector test <br />(M1) <br />26 <br />HSC 25284.2 <br />Annual s2ill containment testinE <br />27 <br />CCR 2636 (f)(4) <br />Annual line tifitness test <br />Mi) <br />28 <br />CCR 2661 (f) <br />Re air for tank/ i2inE has had tightness test <br />(M2) <br />29 <br />1 CCR 2643 (e) <br />Riennial tightness test of Eravity piping (pre -January 1, 1984) <br />—1 <br />30 <br />1 CCR 2643 (d) <br />Triennial line test for conventional suction piping (pre -January 1, 1984) <br />(M1) <br />31 <br />HSC 25292.5 <br />Double wall sXstem located within 1000' of public well-ELD <br />32 <br />CCR 2661 <br />Permit to re air UST system <br />33 <br />HSC 25286 a) <br />Permit to alter monitorinsXstem <br />34 <br />HSC 25298 (b) <br />Permit to tem2orarily close UST system <br />35 <br />HSC 25298 (c) <br />Permit to close UST sXstem <br />36 <br />SC 25299 (a)(9) <br />DisablinE leak detection devices <br />37 <br />SC 25298 (a) <br />Illegal abandonment of UST system <br />38 <br />Other: <br />EHD INSPECTOR: <br />RECEIVED BY: <br />EHD 23-02-002 REV 05/07 <br />PHONE: <br />TITLE: <br />In <br />Septic system: <br />Serves �!20 people/day <br />Receives other than sanitary waste <br />Other disposal methods: <br />- Dry wells/French Drains <br />