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SAN JOAQUIN COUNTY <br /> EINMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor, Stockton, CA 95202-27000 <br /> I Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.or <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> 6i 56^' v l'I'1 im /M ILT I/! !o <br /> Facility address: UST# <br /> 1 0 R? Hwy 12o LLfIZ�N Product <br /> Facility Contact: Title: Phone: <br /> BPR,WVJDifg SIN4(4 DL-�NOZ ( � K3S/-1 S-46 <br /> Monitoring Panel: Pipping system: Overfill prevention: <br /> A4/n, STI k- J P--LP `L 1 Pressurized ❑Suction ❑Gravity Mechanical ❑Audible/visual <br /> Inspection type: -- Violations: <br /> L4outine LR//Monitoring Certification ❑Installation ❑Other: ❑M1-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATIONS) 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 Secondary containment test performed <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 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 /> i 0 CCR 2632(c)(2) UST monitoring system is present Mi' <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 1 Continuous monitoring system for underground piping&UDC is present M1 <br /> 14 CCR 2631 a Primary containment is product tight <br /> 15 HSC 25291 (9A2) Secondary containment for UST is tight <br /> 16 CCR 2636 c)(1) All releases in secondary pipingflow to a collection sum <br /> 17 HSC 25291 Line leak detectors are installed Ml) <br /> 18 CCR 2635(b)(1) Spill container (M2 <br /> 19 CCR 2635(b)(2) Overfill prevention system M2 <br /> 20 CCR 263`6(a) Conventional suction piping shall have continuous monitoring&21 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 (Ml) <br /> 26 HSC 25284.2 Annual spill containment testin <br /> 27 CCR 2636 4 Annual line tightness test Ml <br /> 28 CCR 2661 (f)„ Repair for tank/piping has had tightness test (M2 <br /> 29 CCR 2643 e Biennial tightness test of gravity pipingre-Janus 1, 1984 <br /> 30 CCR 2643(d) Triennial line test for conventional suction piping(pre-January 1' 1984) (Mi) <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 totemporarily 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 Others <br /> EHD INSPECTOR: PHONE: UIC <br /> V _ W30 Septicsystem: <br /> Serves>_20 people/day <br /> RECEIVED BY: TITLE-.f <br /> / Receives other than sanitary waste <br /> O <br /> If <br /> J c. Other disposal methods: <br /> LI Dry wells/French Drains <br /> F.HD 23-02-002 <br />