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SAN JOA UI COUNTY It <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, California 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433We.slaov.org/ehd <br />/�ehd <br />UNDERGROUND STORAGE TANK UST) PROGRAM INSPECTION <br />RF—POKI <br />Facility name: <br />Designated Operator: Inspection <br />Date: <br />\4CL C) <br />z /,?/ <br />-Tac-111ty address: <br />330C) VJtk+e_HQ0 <br />UST# <br />Facility Coroct: Title: Phone: <br />Permit to operate:; <br />Monit ,g Panel. <br />n <br />Piping stem: <br />Overfill prevention: <br />SG <br />9 Pressurized 0 Suction 0 Gravity <br />I$ Mechanical 0 Audible/visual <br />Inspection type: <br />SfPnifflnp id Monitorina Certification 0 Installation 11 Other: <br />Violations: <br />Ml-RDetect El M2-RPrev M-3 Both <br />A <br />EHD 23-02-002 REV 8/08 <br />W <br />a90c system:� <br />L-1 Serves �!20 people/day <br />[I Receives other than sanitary waste <br />Other disposal meth <br />11 Dry wells/French Drains <br />VIOLATION(S) HSC=California Health & Safety Code; CCR=California Code of Regulations <br />Code Section <br />V=Violation; RV=ReUot Violation <br />Permit to operate:; <br />1111154141 <br />Will <br />N <br />Mum. <br />• <br />Monitoring_p4an is onsite. <br />AN111 <br />to <br />Mall <br />(M2 <br />--Spill conta-iner <br />2 <br />•Overfill <br />prevention system <br />KE <br />Annual monitorinq certification <br />f <br />Tnnual �ine leak detector test <br />Annual line tiqhtness test <br />Will <br />(M2LW1 <br />Repair for tank/piping has had tightness test <br />Jill oily <br />Permit to repair LIST system <br />Permit to alter monitoring system <br />W&W4111 <br />HSC 25299 <br />Disabling leak detection devices <br />■ <br />A <br />EHD 23-02-002 REV 8/08 <br />W <br />a90c system:� <br />L-1 Serves �!20 people/day <br />[I Receives other than sanitary waste <br />Other disposal meth <br />11 Dry wells/French Drains <br />