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0 SAN JOAQUIN COUNTV 0 <br />ENVIRONMENTAL HEALTH DEPA1TUEVT <br />600 East Main Street, Stockton, California 95202-3029 <br />11 — .is - I L;.k . - 4 <br />U1100 51 i lliiq� 11 <br />Facility name: <br />Designated Operator: <br />Inspection Date: — <br />M 8P <br />In9t, "t6& <br />41Z 'llige <br />Facility address: <br />UST # 44 - <br />5_1_1 ' " 6 _71 <br />4q-+ #j0,s&qt,6 <br />4,40, <br />�11 <br />Product '7 <br />'04L , If/ <br />Facility Contact: <br />Tit e: Phone: <br />9brIlrWr< <br />0/VYk7_/ 2,3 5-4 <br />Monitoring <br />Panel: <br />Piping system: Overfill prevention: <br />awressurized El Suction El Gravity aechanical El Audible/visual <br />Ins <br />In ectio. type: <br />4'4.nit.,ing <br />Violations: <br />t. <br />Certification El Installation El Other: 11 M I -RDetect 0 M2-RPrev El M-3 Both <br />VIOLATION(S) HSC=Califomia Health& Safety Code; CCR=Califomia Code of Regulations R <br />#T <br />Code Section <br />V=Violation; RY1!S222LYi2!2!i22_ <br />I <br />HSC 25284 <br />_V <br />Permit tooperate <br />2 <br />CCR 2637 <br />Seconda containment test erformed <br />3 <br />CCR 2711 (b) & (c) <br />Current Unified Pro ram Consolidated Forms on file with EHD Facility and tank form) <br />4 <br />HSC 25292.2 <br />Certification of financial res�onsibility �and CFO letter <br />5 <br />CCR 2632 b <br />Monitorin Proram (Monitoring & Response Plan) is current and approved by the local agency. <br />6 <br />CCR 2712 (i) <br />Monitorin1an is onsite. <br />7 <br />CCR 2712 (b) <br />Maintenance & monitoring records (M 1) <br />8 <br />CCR 2643 (d) <br />Daily monitoring of suction 1, 1984) <br />9 <br />HSC 25292.1 <br />_2jnjaL2rc-Januaa, <br />UST system isoperated to prevent unauthorized release <br />- ----- <br />(0 <br />CCR 2632 c)(2) <br />UST monitorinE system is present (MI) <br />11 <br />CCR 2630 (d <br />UST s stem monitorin e uiiment is ro erl located to detect a leak (Ml <br />12 <br />HSC 25291 (b) <br />UST system monitoring equipment isoperational (M2) <br />13 <br />CCR 2636 (t)(1) <br />Continuous monitoring system for underground piping & UDC is present (M 1) <br />14 <br />CCR 2631 a) <br />Primary containment is product tight <br />15 <br />HSC 25291 a)(2)_ <br />Secondary containment for UST is ti ht <br />16 <br />CCR 2636 cI) <br />All releases in secondary piping flow to a collection sump <br />17 <br />HSC 25291 (t) --Line <br />leak detectorsare installed (M1) <br />18 <br />CCR 2635 (b)(1) <br />Spill container (M2) <br />19 <br />CCR 2635 (b <br />L 2 <br />Overfill 2revention system (M2) <br />20 <br />CCR 2636 (a) <br />Conventional suction pipinE shall have continuous monitorin & 2° containment <br />21 <br />HSC 25291 (e) <br />Water in 2' containment analyzed & properly disposed of <br />22 <br />CCR 2650 <br />Recording/re 2porti1naag of releases <br />23 <br />—CCR 2715 <br />Designated Operator: (a) Statement from UST owner; (c -e) Monthly ins2ection; (f) Em 310Zee trainma <br />24 <br />CCR 2638 (a) <br />Annual monitorin certification <br />25 <br />CCR 2638 (a) <br />Annual line leak detector test (MI), <br />26 <br />HSC 25284.2 <br />Annual spill containment testing <br />7 <br />CCR 2636 4) <br />Annual line tightness test (M1) <br />28 <br />CCR 2661 (f) <br />Repair for tank/piping has had tightness test (M2) <br />29 <br />CCR 2643 (e) <br />Biennial tightness test of gravity piping (pre -January 1, 1984) <br />30 <br />CCR 2643 d) <br />Triennial line test for conventional suction piping (pre-Januaa 1, 1984) (M 1) <br />31 <br />HSC 25292.5 <br />Double wall system located within 1000' of public well-ELD <br />32 <br />CCR 2661 <br />Pen -nit to repair UST system <br />33 <br />HSC 25286 (a) <br />Pen -nit to alter monitoring system <br />34 <br />1 HSC 25298 b) <br />Permit to temporarily close UST system <br />35 <br />HSC 25298 1c) <br />Permit to close <br />36 <br />HSC 25299 (a)(9) <br />Disabling leak detection devices <br />37 <br />HSC 25298 1a) <br />Illegal abandonment of UST system <br />38 <br />Other: <br />EHD INSPECTOR: <br />PHONE: UIC <br />t JI <br />e <br />46 9- 3 (k? Smtic system: <br />Serves �!20 people/day <br />RECEIVE <br />RECEIVE <br />TITLE: Receives other than sanitary waste <br />V -Y\ Other disposal methods: <br />Drywells/French Drains <br />`i <br />EHD 23-02-002 REV 05/07 <br />