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��u st ry'• <br />�° co SAN JOAQUIN COUNTY <br />d <br />{} ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, aid 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 <br />REPORY <br />Facility name: <br />1 <br />Designated Operator: Inspection Date: <br />Mel- is'ol pe% PVT94LUM <br />1vlClk- D&QA0159 G%f 7/0-7 <br />Facility address: <br />Secondary containment test erfonned <br />UST # <br />3 <br />CCR 2711 (b) & (c) <br />Product -'�4 I— <br />Facility Contact: Title: <br />Phone: <br />CZoel) 2- 09-W <br />Certification of financial responsibility and CFO letter <br />Nic.Ic. 8c%�etr%�s � w AI <br />�� <br />Monitoring Panel: <br />m-- ,� 35-D <br />Piping system: <br />vressurized ❑ Suction <br />❑ Gravity <br />Overfill prevention: <br />C�echanical ❑ Audible/visual <br />Inspection type: <br />violations: <br />34 outine N4onitoring Certification ❑ Installation <br />❑ Other: <br />❑ M1-RDetect ❑ M2-RPrev ❑ M-3 Both <br /># <br />Code Section <br />VIOLATIONS) HSC=Califomia Health & Safety Code; CCR=California Code of Regulations v x <br />V <br />V=Violation; RV=Re eat Violation <br />1 <br />HSC 25284 <br />Permit tooperate <br />2 <br />CCR 2637 <br />Secondary containment test erfonned <br />3 <br />CCR 2711 (b) & (c) <br />Current Unified Pro am Consolidated Forms on file with EHD (Facility and tank form <br />4 <br />HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />5 <br />CCR 2632 (c)(2)(D) <br />Monitoring & response plan is current and filed with the local a enc <br />6 <br />CCR 2712 i <br />MonitorinE & response plan is onsite <br />7 <br />CCR 2712 b <br />Maintenance & monitorin records <br />Ml <br />8 <br />CCR 2643 d <br />Daily monitoring of suction piping (pre -January, 1, 1984 <br />9 <br />HSC 25292.1 <br />UST system isoperated to prevent unauthorized release <br />10 <br />CCR 2632 (c)(2) <br />UST monitoring system is present <br />Ml <br />11 <br />CCR 2630 (d) <br />UST system monitoring equipment is 2roperly located to detect a leak <br />MI <br />12 <br />HSC 25291 b <br />UST s stem monitoring equipment isoperational <br />M2 <br />13 <br />CCR 2636 1) <br />Continuous monitorinE system for underground 2i2ing & UDC is present <br />Ml <br />14 <br />CCR 2631 a <br />Primary containment is product ti ht <br />15 <br />HSC 25291 (a)(2) <br />Secondary containment for UST is tight <br />16 <br />CCR 2636 (c)(1) <br />All releases in secondary Pi2ingflow to a collection sum <br />17 <br />HSC 25291 <br />Line leak detector(s) are installed <br />(Ml) <br />18 <br />CCR 2635 1 <br />Spill container <br />M2 <br />19 <br />CCR 2635 (b)(2) <br />Overfill prevention system <br />(M2) <br />20 <br />CCR 2636 (a) <br />Conventional suction piping shall have continuous monitoring & 21 containment <br />21 <br />HSC 25291 (e) <br />Water in 20 containment analyzed & properly disposed of <br />22 <br />CCR 2650 <br />Recordin reporting of unauthorized releases <br />l <br />23 <br />CCR 2715 <br />Designated Operator(a) Statement from UST owner; (c -e) Monthly inspection; (f) Employee training <br />24 <br />CCR 2638 (a) <br />Annual monitoring certification <br />25 <br />CCR 2638 (a) <br />Annual line leak detector test <br />(MI) <br />26 <br />HSC 25284.2 <br />Annuals ill containment testing <br />27 <br />CCR 2636 (f)(4) <br />Annual line tightness test <br />(M1) <br />28 <br />CCR 2661 <br />Repair for tank/piping has had tightness test <br />M2 <br />29 <br />CCR 2643 (e) <br />Biennial tightness test of gravity pipinE(re-Janna 1, 19 84) <br />30 <br />CCR 2643 d <br />Triennial line test for conventional suction pipinE (pre-January1, 1984 <br />MI <br />31 <br />HSC 25292.5 <br />Double walls stem located within 1000' of public well-ELD <br />32 <br />CCR 2661 <br />Permit to re air UST s stem <br />33 <br />HSC 25286 a) <br />Permit to alter monitoring system <br />34 <br />HSC 25298 b <br />Permit to teMporarily temporarilyclose UST system <br />35 <br />HSC 25298 c) <br />Permit to close UST system <br />36 <br />HSC 25299 (aj(9) <br />Disabling leak detection devices <br />37 <br />HSC 25298 (a) <br />Ille al abandonment of UST system <br />38 <br />Other: <br />EHD INSPECTOR: <br />KAg-34 <br />RECEIV BY: <br />/j a _ <br />.ten �i�I/i <br />PHONE: <br />_ZCI <br />TITLE: <br />/ i�.�%�'1�,1��J <br />UIC <br />Septic system: <br />❑ Serves >_20 people/day <br />❑ Receives other than sanitary waste <br />Other disposal methods: <br />❑ Dry wells/French Drains <br />EHD 23-02 <br />1/3/07 <br />